Healthcare Provider Details

I. General information

NPI: 1245973726
Provider Name (Legal Business Name): MOUNTAIN WEST MEDICAL EQUIPMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2022
Last Update Date: 04/15/2022
Certification Date: 04/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2516 E SNOW MOUNTAIN DR
SANDY UT
84093-1858
US

IV. Provider business mailing address

2516 E SNOW MOUNTAIN DR
SANDY UT
84093-1858
US

V. Phone/Fax

Practice location:
  • Phone: 801-900-3221
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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: KEVIN MANGUM
Title or Position: CEO
Credential: DO
Phone: 801-486-3021