=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275603888
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MOUNTAIN WEST MEDICAL INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/09/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 120 S STATE ST SUITE B
-----------------------------------------------------
City | CLEARFIELD
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84015-1010
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-825-2300
-----------------------------------------------------
Fax | 801-779-0807
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 666
-----------------------------------------------------
City | CLEARFIELD
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84089-0666
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-825-2300
-----------------------------------------------------
Fax | 801-779-0807
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MRS. SHARON WEST
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 801-825-2300
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332BX2000X
-----------------------------------------------------
Taxonomy Name | Oxygen Equipment & Supplies (DME)
-----------------------------------------------------
License Number | D67761
-----------------------------------------------------
License Number State | UT
-----------------------------------------------------