MEDICARE: MED ONE MEDICAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QS1200X	Sleep Disorder Diagnostic Clinic/Center	17686	UT

General Provider Information

NPI Number	:	1194723650
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MED ONE MEDICAL

Provider Business Mailing Address
First Line	:	6965 UNION PARK CTR
Second Line	:	#400
City	:	MIDVALE
State	:	UT
Zip	:	84047-6008
Country	:	US
Telephone Number	:	801-566-6433
Fax Number	:	801-304-0076

Provider Business Practice Location Address
First Line	:	6965 UNION PARK CTR
Second Line	:	#400
City	:	MIDVALE
State	:	UT
Zip	:	84047-6008
Country	:	US
Telephone Number	:	801-566-6433
Fax Number	:	801-304-0076

Authorized Official
Title or Position	:	OWNER
Name	:	MR. MICHAEL R TREACY
Credential	:
Telephone Number	:	801-566-6433

Provider Enumeration Date	:	07/08/2005
Last Update Date	:	08/22/2020

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