Healthcare Provider Details

I. General information

NPI: 1730558115
Provider Name (Legal Business Name): BYRAM HEALTHCARE CENTERS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2015
Last Update Date: 04/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3793 S STATE ST
SALT LAKE CITY UT
84115-4828
US

IV. Provider business mailing address

3793 S STATE ST
SALT LAKE CITY UT
84115-4828
US

V. Phone/Fax

Practice location:
  • Phone: 801-716-8797
  • Fax: 866-478-9348
Mailing address:
  • Phone: 801-716-8797
  • Fax: 866-478-9348

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number9623310-1703
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: PERRY A BERNOCCHI
Title or Position: CEO
Credential:
Phone: 714-895-6416