Healthcare Provider Details

I. General information

NPI: 1487896650
Provider Name (Legal Business Name): EXPRESS MEDICAL TECHNOLOGY L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2009
Last Update Date: 04/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1467 W CENTER ST
OREM UT
84057-5104
US

IV. Provider business mailing address

1467 W CENTER ST
OREM UT
84057-5104
US

V. Phone/Fax

Practice location:
  • Phone: 801-769-2421
  • Fax:
Mailing address:
  • Phone: 801-769-2421
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number7267987-1714
License Number StateUT

VIII. Authorized Official

Name: MR. HOWARD PATRICK HOLMAN
Title or Position: PRESIDENT / CEO
Credential:
Phone: 801-796-1686