MEDICARE: PECTUS SERVICES OF UTAH

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	332BC3200X	Customized Equipment (DME)

General Provider Information

NPI Number	:	1366747495
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PECTUS SERVICES OF UTAH

Provider Business Mailing Address
First Line	:	96 BELMOHR ST
Second Line	:
City	:	BELLEVILLE
State	:	NJ
Zip	:	07109-2202
Country	:	US
Telephone Number	:	877-732-8876
Fax Number	:	973-488-7185

Provider Business Practice Location Address
First Line	:	877 E VINE ST
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84107-6515
Country	:	US
Telephone Number	:	877-732-8876
Fax Number	:	973-488-7185

Authorized Official
Title or Position	:	OWNER
Name	:	JOSEPH PORCELLO
Credential	:
Telephone Number	:	877-732-8876

Provider Enumeration Date	:	01/21/2011
Last Update Date	:	01/21/2011

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Directions to “PECTUS SERVICES OF UTAH ” Practice Location

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