MEDICARE: SLC MEDICAL SUPPLIES 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	:	1770434557
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SLC MEDICAL SUPPLIES LLC

Provider Business Mailing Address
First Line	:	1278 S PROSPECT ST
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84104-4129
Country	:	US
Telephone Number	:	801-558-8151
Fax Number	:

Provider Business Practice Location Address
First Line	:	1278 S PROSPECT ST
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84104-4129
Country	:	US
Telephone Number	:	801-558-8151
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	NASEEB ROSHAN
Credential	:
Telephone Number	:	801-558-8151

Provider Enumeration Date	:	02/06/2026
Last Update Date	:	02/06/2026

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