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General NPI Number Information
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NPI Number | 1629027560
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Entity Type | Organization
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Legal Business Name | SHIELDS ORTHOTIC PROSTHETIC SERVICES, INC.
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Dates
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Enumeration Date | 05/09/2006
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Last Update Date | 10/17/2014
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Provider Practice Location Address
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Address Line | 5687 HARRISON BLVD
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City | SOUTH OGDEN
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State | UT
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Zip | 84403-4322
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Country | US
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Telephone | 801-475-4428
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Fax | 801-475-0427
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Provider Business Mailing Address
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Address Line | 2785 E 3300 S
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City | SALT LAKE CITY
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State | UT
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Zip | 84109-2818
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Country | US
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Telephone | 801-467-5483
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Fax | 801-484-4591
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Authorized Official
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Title or Position | DIRECTOR OF REIMBURSEMENT
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Name | MS. SHERYL S PRICE
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Credential |
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Telephone | 503-493-8288
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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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Taxonomy #2
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State |
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