Provider Demographics
NPI:1588228811
Name:ARAGON MEDICAL
Entity Type:Organization
Organization Name:ARAGON MEDICAL
Other - Org Name:ARAGON MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GWENDI
Authorized Official - Middle Name:RENE
Authorized Official - Last Name:DEAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-362-5500
Mailing Address - Street 1:9980 S 300 W STE 200
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84070-3654
Mailing Address - Country:US
Mailing Address - Phone:385-495-4151
Mailing Address - Fax:844-596-0409
Practice Address - Street 1:9980 S 300 W STE 200
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84070-3654
Practice Address - Country:US
Practice Address - Phone:385-495-4151
Practice Address - Fax:844-596-0409
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-23
Last Update Date:2020-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No251E00000XAgenciesHome Health
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing FacilityGroup - Multi-Specialty