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General NPI Number Information
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NPI Number | 1619519840
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Entity Type | Organization
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Legal Business Name | PLATINUM VENTURE GROUP LLC
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Dates
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Enumeration Date | 10/09/2019
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Last Update Date | 04/29/2021
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Provider Practice Location Address
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Address Line | 7071 N 138TH AVE BLDG 1540
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City | GLENDALE
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State | AZ
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Zip | 85307-2006
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Country | US
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Telephone | 623-248-4275
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Fax | 623-248-4273
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Provider Business Mailing Address
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Address Line | 848 E WOODOAK LN
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City | MURRAY
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State | UT
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Zip | 84107-6370
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Country | US
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Telephone | 623-248-4275
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Fax | 623-248-4273
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Authorized Official
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Title or Position | CEO
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Name | JEROME STARKS
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Credential |
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Telephone | 801-214-9918
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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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