Provider Demographics
NPI:1497191001
Name:PULMONARY HEALTH SERVICES
Entity Type:Organization
Organization Name:PULMONARY HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MISS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:CANNON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-266-0399
Mailing Address - Street 1:4885 S 900 E STE 107
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84117-3905
Mailing Address - Country:US
Mailing Address - Phone:801-266-0399
Mailing Address - Fax:801-266-0421
Practice Address - Street 1:2307 N HILL FIELD RD STE 102
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-6890
Practice Address - Country:US
Practice Address - Phone:801-266-0399
Practice Address - Fax:801-266-0421
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-22
Last Update Date:2014-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6209500-5701227800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes227800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, CertifiedGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT103007426101OtherSELECTHEALTH
UT44447000001001OtherBLUE CROSS PROVIDER NUMBER
UT61101OtherHUMANA
UT73301OtherPEHP
UT781709OtherDESERET MUTUAL
UTQM000064662OtherALTIUS
UTP00291261OtherRR MEDICARE
UTQM000064662OtherALTIUS