Provider Demographics
NPI:1477926806
Name:REMACK LLC
Entity Type:Organization
Organization Name:REMACK LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:BARNARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-938-8508
Mailing Address - Street 1:7198 W HIGHWAY 30
Mailing Address - Street 2:
Mailing Address - City:MENDON
Mailing Address - State:UT
Mailing Address - Zip Code:84325-9713
Mailing Address - Country:US
Mailing Address - Phone:435-760-7003
Mailing Address - Fax:
Practice Address - Street 1:2380 N 400 E
Practice Address - Street 2:STE C
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84341-6000
Practice Address - Country:US
Practice Address - Phone:435-753-7337
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-06
Last Update Date:2016-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT309737-4405261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT363LP0808XMedicaid