MEDICARE: REHAB MEDICAL OF SALT LAKE, 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	332BX2000X	Oxygen Equipment & Supplies (DME)	000214	UT
2	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1912936865
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REHAB MEDICAL OF SALT LAKE, LLC

Provider Business Mailing Address
First Line	:	3750 PRIORITY WAY SOUTH DR
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46240-3831
Country	:	US
Telephone Number	:	317-436-6178
Fax Number	:	855-671-9194

Provider Business Practice Location Address
First Line	:	3690 S 500 W
Second Line	:	SUITE 104
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84115
Country	:	US
Telephone Number	:	801-713-4187
Fax Number	:	801-713-0517

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. PATRICK MCGINLEY
Credential	:
Telephone Number	:	317-813-0205

Provider Enumeration Date	:	07/02/2006
Last Update Date	:	10/25/2024

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