Healthcare Provider Details

I. General information

NPI: 1891547147
Provider Name (Legal Business Name): THE I.V. CREW, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2024
Last Update Date: 04/02/2024
Certification Date: 04/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2941 S FILMORE ST
SALT LAKE CITY UT
84106-3465
US

IV. Provider business mailing address

2941 S FILMORE ST
SALT LAKE CITY UT
84106-3465
US

V. Phone/Fax

Practice location:
  • Phone: 801-580-0903
  • Fax:
Mailing address:
  • Phone: 801-580-0903
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WI0500X
TaxonomyInfusion Therapy Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: JAY H LARSEN
Title or Position: OWNER
Credential: RN
Phone: 801-580-0903