Healthcare Provider Details

I. General information

NPI: 1982885422
Provider Name (Legal Business Name): STEVENSONS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/26/2007
Last Update Date: 11/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 EAST WILMINGTON AVE
SALT LAKE CITY UT
84106-1421
US

IV. Provider business mailing address

620 EAST WILMINGTON AVE.
SALT LAKE CITY UT
84106-1421
US

V. Phone/Fax

Practice location:
  • Phone: 801-466-2884
  • Fax: 801-466-2884
Mailing address:
  • Phone: 801-466-2884
  • Fax: 801-466-2884

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: STEVEN D WENGREN
Title or Position: OWNER/ MANAGER
Credential: C.PED.
Phone: 801-466-2884