Healthcare Provider Details

I. General information

NPI: 1780728535
Provider Name (Legal Business Name): DESERET MEDICAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2007
Last Update Date: 02/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 W FINE DR
SALT LAKE CITY UT
84115
US

IV. Provider business mailing address

560 WEST FINE DR
SALT LAKE CITY UT
84115
US

V. Phone/Fax

Practice location:
  • Phone: 801-270-8440
  • Fax: 801-293-9000
Mailing address:
  • Phone: 801-270-8440
  • Fax: 801-293-9000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number5087382-1714
License Number StateUT

VIII. Authorized Official

Name: MR. GEREG P BOISJOLIE
Title or Position: PRESIDENT
Credential:
Phone: 801-544-2002