Provider Demographics
NPI:1073155941
Name:RED PINE HEALTH SUPPLY
Entity Type:Organization
Organization Name:RED PINE HEALTH SUPPLY
Other - Org Name:DME SOLUTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PRESTON
Authorized Official - Middle Name:
Authorized Official - Last Name:BOUTSIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-805-1906
Mailing Address - Street 1:89 W WRANGLER AVE
Mailing Address - Street 2:
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:UT
Mailing Address - Zip Code:84045-3937
Mailing Address - Country:US
Mailing Address - Phone:801-682-3865
Mailing Address - Fax:
Practice Address - Street 1:89 W WRANGLER AVE
Practice Address - Street 2:
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:UT
Practice Address - Zip Code:84045-3937
Practice Address - Country:US
Practice Address - Phone:801-682-3865
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-11
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies