Provider Demographics
NPI:1356481337
Name:MAJIC REST, INC.
Entity Type:Organization
Organization Name:MAJIC REST, INC.
Other - Org Name:MAGIC REST MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXEC. GEN. MGR.
Authorized Official - Prefix:MR
Authorized Official - First Name:J
Authorized Official - Middle Name:
Authorized Official - Last Name:GRYGOTIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-281-8688
Mailing Address - Street 1:PO BOX 65785
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84165-0785
Mailing Address - Country:US
Mailing Address - Phone:801-281-8688
Mailing Address - Fax:801-281-4159
Practice Address - Street 1:3540 S MAIN ST
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84115-4435
Practice Address - Country:US
Practice Address - Phone:801-281-8688
Practice Address - Fax:801-281-4159
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT001467332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT=========-008Medicaid