Healthcare Provider Details

I. General information

NPI: 1447632013
Provider Name (Legal Business Name): PLATINUM VENTURE GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2015
Last Update Date: 07/18/2023
Certification Date: 07/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8522 S 1300 E STE 103
SANDY UT
84094-1391
US

IV. Provider business mailing address

8522 S 1300 E STE 103
SANDY UT
84094-1391
US

V. Phone/Fax

Practice location:
  • Phone: 801-214-9918
  • Fax: 385-533-5007
Mailing address:
  • Phone: 801-214-9918
  • Fax: 385-533-5007

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: VALREEN WILLNA JOHN
Title or Position: OWNER
Credential:
Phone: 801-214-9918