=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497191001
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PULMONARY HEALTH SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/22/2013
-----------------------------------------------------
Last Update Date | 08/21/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2307 N HILL FIELD RD STE 102
-----------------------------------------------------
City | LAYTON
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84041-6890
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-266-0399
-----------------------------------------------------
Fax | 801-266-0421
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4885 S 900 E STE 107
-----------------------------------------------------
City | SALT LAKE CITY
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84117-3905
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-266-0399
-----------------------------------------------------
Fax | 801-266-0421
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF EXECUTIVE OFFICER
-----------------------------------------------------
Name | MISS MARY CANNON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 801-266-0399
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 227800000X
-----------------------------------------------------
Taxonomy Name | Certified Respiratory Therapist
-----------------------------------------------------
License Number | 6209500-5701
-----------------------------------------------------
License Number State | UT
-----------------------------------------------------