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General NPI Number Information
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NPI Number | 1700278280
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Entity Type | Organization
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Legal Business Name | EDISON STANFORD
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Dates
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Enumeration Date | 02/20/2015
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Last Update Date | 02/20/2015
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Provider Practice Location Address
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Address Line | 1817 S MAIN ST 7
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City | SALT LAKE CITY
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State | UT
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Zip | 84115-2036
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Country | US
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Telephone | 801-485-5595
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Fax |
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Provider Business Mailing Address
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Address Line | 1817 S MAIN ST 7
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City | SALT LAKE CITY
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State | UT
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Zip | 84115-2036
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Country | US
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Telephone | 801-485-5595
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Fax |
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Authorized Official
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Title or Position | HEARING INSTRUMENT SPECIALIST
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Name | AMBER A LLOYD
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Credential | BC-HIS, ACA
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Telephone | 801-485-5595
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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 | 4988314-4601
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License Number State | UT
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