Healthcare Provider Details

I. General information

NPI: 1588011688
Provider Name (Legal Business Name): ECLIPSE MOBILITY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2016
Last Update Date: 09/15/2021
Certification Date: 09/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1051 S 500 W STE D
WOODS CROSS UT
84010-8350
US

IV. Provider business mailing address

1051 S 500 W STE D
WOODS CROSS UT
84010-8350
US

V. Phone/Fax

Practice location:
  • Phone: 801-217-3551
  • Fax: 844-544-7220
Mailing address:
  • Phone: 801-217-3551
  • Fax: 844-544-7220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number9784687-1714
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number9784687-1714
License Number StateUT

VIII. Authorized Official

Name: LANDON J CLEVERLY
Title or Position: MANAGER/OWNER
Credential:
Phone: 801-842-6106