Healthcare Provider Details

I. General information

NPI: 1760730659
Provider Name (Legal Business Name): MERCURY MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2012
Last Update Date: 08/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3385 W 2525 N
PLAIN CITY UT
84404
US

IV. Provider business mailing address

3385 W 2525 N
PLAIN CITY UT
84404
US

V. Phone/Fax

Practice location:
  • Phone: 801-644-5121
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number8374133-0160
License Number StateUT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: PATRIC BRADY HESS
Title or Position: CEO
Credential:
Phone: 801-644-5121