MEDICARE: BIWATER SURGICAL MONITORING, LLC

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	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1245341569
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BIWATER SURGICAL MONITORING, LLC

Provider Business Mailing Address
First Line	:	4505 WASATCH BLVD
Second Line	:	SUITE 370
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84124-4709
Country	:	US
Telephone Number	:	801-947-9007
Fax Number	:	801-947-9994

Provider Business Practice Location Address
First Line	:	4505 WASATCH BLVD
Second Line	:	SUITE 370
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84124-4709
Country	:	US
Telephone Number	:	801-947-9007
Fax Number	:	801-947-9994

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	MR. RADD C BERRETT
Credential	:
Telephone Number	:	801-947-9007

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	02/17/2010

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