Healthcare Provider Details

I. General information

NPI: 1023484656
Provider Name (Legal Business Name): SORTIAMO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2015
Last Update Date: 08/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8510 S SANDY PKWY
SANDY UT
84070-6422
US

IV. Provider business mailing address

PO BOX 127
WEST JORDAN UT
84084-0127
US

V. Phone/Fax

Practice location:
  • Phone: 801-955-4949
  • Fax: 801-955-0336
Mailing address:
  • Phone: 801-955-4949
  • Fax: 801-955-0336

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number12409478-004-STC
License Number StateUT

VIII. Authorized Official

Name: JAMES LEFEVRE
Title or Position: CEO
Credential:
Phone: 801-955-4949