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General NPI Number Information
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NPI Number | 1275008047
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Entity Type | Organization
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Legal Business Name | SEGO MED SUPPLY, LLC
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Dates
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Enumeration Date | 10/09/2018
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Last Update Date | 12/18/2024
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Provider Practice Location Address
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Address Line | 6351 W 13400 S STE 102
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City | HERRIMAN
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State | UT
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Zip | 84096-5790
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Country | US
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Telephone | 801-694-7428
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Fax |
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Provider Business Mailing Address
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Address Line | 4936 W DESERT SAGE DR
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City | HERRIMAN
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State | UT
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Zip | 84096-3436
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Country | US
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Telephone | 801-699-9458
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SERGIO NOGUEIRA
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Credential |
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Telephone | 801-694-7428
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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