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General NPI Number Information
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NPI Number | 1558887927
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Entity Type | Organization
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Legal Business Name | FOOTHILL MEDICAL SUPPLY, LLC
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Dates
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Enumeration Date | 08/17/2017
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Last Update Date | 10/29/2021
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Provider Practice Location Address
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Address Line | 723 N 1890 W STE 38A
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City | PROVO
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State | UT
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Zip | 84601-1333
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Country | US
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Telephone | 877-464-5846
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Fax | 877-492-2716
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Provider Business Mailing Address
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Address Line | 723 N 1890 W STE 38A
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City | PROVO
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State | UT
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Zip | 84601-1333
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Country | US
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Telephone | 877-492-2704
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Fax | 877-492-2716
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Authorized Official
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Title or Position | CHIEF FINANCIAL OFFICER
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Name | WAYNE REAVES
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Credential |
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Telephone | 801-492-2704
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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 | 10186558-1714
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License Number State | UT
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