Provider Demographics
NPI:1568022606
Name:MDS MEDICAL DEVICE SPECIALTY INC.
Entity Type:Organization
Organization Name:MDS MEDICAL DEVICE SPECIALTY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:JOLLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:801-475-0303
Mailing Address - Street 1:270 W 500 N
Mailing Address - Street 2:
Mailing Address - City:NORTH SALT LAKE
Mailing Address - State:UT
Mailing Address - Zip Code:84054-2769
Mailing Address - Country:US
Mailing Address - Phone:801-475-0303
Mailing Address - Fax:888-455-8597
Practice Address - Street 1:116 E MARKET ST STE 110
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-5793
Practice Address - Country:US
Practice Address - Phone:888-518-5110
Practice Address - Fax:877-475-0303
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MDS MEDICAL DEVICE SPECIALTY INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-06-20
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies