Provider Demographics
NPI:1235232588
Name:ORTHO-MED CENTER, INC.
Entity Type:Organization
Organization Name:ORTHO-MED CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:STORE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNA
Authorized Official - Middle Name:SHELAYNE
Authorized Official - Last Name:PAULSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-272-4253
Mailing Address - Street 1:2242 FORT UNION BOULEVARD
Mailing Address - Street 2:SUITE A4 & A5
Mailing Address - City:COTTONWOOD HEIGHTS
Mailing Address - State:UT
Mailing Address - Zip Code:84121-5551
Mailing Address - Country:US
Mailing Address - Phone:801-272-4253
Mailing Address - Fax:801-273-1283
Practice Address - Street 1:2242 FORT UNION BOULEVARD
Practice Address - Street 2:SUITE A4 & A5
Practice Address - City:COTTONWOOD HEIGHTS
Practice Address - State:UT
Practice Address - Zip Code:84121-5551
Practice Address - Country:US
Practice Address - Phone:801-272-4253
Practice Address - Fax:801-273-1283
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-05
Last Update Date:2012-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UTE42342332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1162340001Medicare NSC