MEDICARE: ORBIT MEDICAL INC

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	7721183-1714	UT

General Provider Information

NPI Number	:	1851601884
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ORBIT MEDICAL INC

Provider Business Mailing Address
First Line	:	716 E 4500 S
Second Line	:	SUITE 260S
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84107-3080
Country	:	US
Telephone Number	:	801-713-2020
Fax Number	:

Provider Business Practice Location Address
First Line	:	4424 S 700 E
Second Line	:	SUITE 200
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84107-3606
Country	:	US
Telephone Number	:	801-713-2020
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. ROBERT GALLUP
Credential	:
Telephone Number	:	801-713-2020

Provider Enumeration Date	:	10/08/2010
Last Update Date	:	10/08/2010

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