Healthcare Provider Details

I. General information

NPI: 1689959215
Provider Name (Legal Business Name): SYNERGY DME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2011
Last Update Date: 10/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 S 600 E
SALT LAKE CITY UT
84102
US

IV. Provider business mailing address

510 S 600 E
SALT LAKE CITY UT
84102-2710
US

V. Phone/Fax

Practice location:
  • Phone: 970-712-7787
  • Fax:
Mailing address:
  • Phone: 970-712-7787
  • Fax:

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: MRS. RACHAEL S CRUZ
Title or Position: OWNER
Credential:
Phone: 970-712-7787