Provider Demographics
NPI:1609251800
Name:LEGRAND BINGHAM INC
Entity Type:Organization
Organization Name:LEGRAND BINGHAM INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEGRAND
Authorized Official - Middle Name:
Authorized Official - Last Name:BINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:435-753-7563
Mailing Address - Street 1:120 W CACHE VALLEY BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84341-2696
Mailing Address - Country:US
Mailing Address - Phone:435-753-7563
Mailing Address - Fax:435-753-0886
Practice Address - Street 1:120 W CACHE VALLEY BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84341-2696
Practice Address - Country:US
Practice Address - Phone:435-753-7563
Practice Address - Fax:435-753-0886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-29
Last Update Date:2015-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT141029332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies