Provider Demographics
NPI:1093337537
Name:ACT MEDICAL SUPPLY INC
Entity Type:Organization
Organization Name:ACT MEDICAL SUPPLY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EMIL
Authorized Official - Middle Name:AUGUST
Authorized Official - Last Name:WOLFGRAMM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-597-7876
Mailing Address - Street 1:3713 W MERCED CIR
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:UT
Mailing Address - Zip Code:84065-8007
Mailing Address - Country:US
Mailing Address - Phone:801-597-9796
Mailing Address - Fax:
Practice Address - Street 1:3713 W MERCED CIR
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:UT
Practice Address - Zip Code:84065-8007
Practice Address - Country:US
Practice Address - Phone:801-597-9796
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-07
Last Update Date:2020-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies