Healthcare Provider Details

I. General information

NPI: 1255704060
Provider Name (Legal Business Name): DURAMED LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2015
Last Update Date: 08/26/2021
Certification Date: 08/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2164 S RICHARDS ST
SALT LAKE CITY UT
84115-2606
US

IV. Provider business mailing address

2164 S RICHARDS ST
SALT LAKE CITY UT
84115-2606
US

V. Phone/Fax

Practice location:
  • Phone: 888-512-5256
  • Fax:
Mailing address:
  • Phone: 888-512-5256
  • Fax: 888-522-0355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DARIN WILLIAM JOHNCOCK
Title or Position: PRESIDENT
Credential:
Phone: 888-412-8087