Provider Demographics
NPI:1467606137
Name:BLUE ROCK PROPERTIES LLC
Entity Type:Organization
Organization Name:BLUE ROCK PROPERTIES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:HODGES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-437-4895
Mailing Address - Street 1:280 RIVER PARK DR
Mailing Address - Street 2:100
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-5764
Mailing Address - Country:US
Mailing Address - Phone:801-437-4895
Mailing Address - Fax:801-229-1003
Practice Address - Street 1:130 S 400 W
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84101-1145
Practice Address - Country:US
Practice Address - Phone:801-456-7226
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-07
Last Update Date:2009-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT20022355247100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistGroup - Multi-Specialty