Provider Demographics
NPI:1295857506
Name:MYTREX INC
Entity Type:Organization
Organization Name:MYTREX INC
Other - Org Name:RESCUE ALERT
Other - Org Type:Other Name
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:REO
Authorized Official - Middle Name:
Authorized Official - Last Name:LARSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-571-4121
Mailing Address - Street 1:10321 BECKSTEAD LN
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-8801
Mailing Address - Country:US
Mailing Address - Phone:801-571-4121
Mailing Address - Fax:801-571-4606
Practice Address - Street 1:10321 BECKSTEAD LN
Practice Address - Street 2:
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095-8801
Practice Address - Country:US
Practice Address - Phone:801-571-4121
Practice Address - Fax:801-571-4606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2017-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========033OtherSALT LAKE COUNTY