MEDICARE: MERCURY MEDICAL 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	8374133-0160	UT

General Provider Information

NPI Number	:	1760730659
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MERCURY MEDICAL LLC

Provider Business Mailing Address
First Line	:	3385 W 2525 N
Second Line	:
City	:	PLAIN CITY
State	:	UT
Zip	:	84404
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3385 W 2525 N
Second Line	:
City	:	PLAIN CITY
State	:	UT
Zip	:	84404
Country	:	US
Telephone Number	:	801-644-5121
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	PATRIC BRADY HESS
Credential	:
Telephone Number	:	801-644-5121

Provider Enumeration Date	:	08/27/2012
Last Update Date	:	08/27/2012

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