Healthcare Provider Details

I. General information

NPI: 1952865412
Provider Name (Legal Business Name): AVAIL MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2019
Last Update Date: 01/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5742 S 1475 E STE 200
SOUTH OGDEN UT
84403-4856
US

IV. Provider business mailing address

PO BOX 446
HUNTSVILLE UT
84317-0446
US

V. Phone/Fax

Practice location:
  • Phone: 801-438-4438
  • Fax: 801-469-4499
Mailing address:
  • Phone: 801-438-4438
  • Fax: 801-469-4499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: JOSHUA SHEPARD
Title or Position: MEDICAL DIRECTOR
Credential: DO
Phone: 801-438-4388