Provider Demographics
NPI:1649395336
Name:KEY MEDICAL LLC
Entity Type:Organization
Organization Name:KEY MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:GLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:NEWSOM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-266-3220
Mailing Address - Street 1:5796 S 900 E
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84121-1036
Mailing Address - Country:US
Mailing Address - Phone:801-266-3220
Mailing Address - Fax:800-927-7197
Practice Address - Street 1:5796 S 900 E
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84121-1036
Practice Address - Country:US
Practice Address - Phone:801-266-3220
Practice Address - Fax:800-927-7197
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT95640500000001OtherBCBS PROVIDER NUMBER
UT95640500000001OtherBCBS PROVIDER NUMBER
UT95640500000001OtherBCBS PROVIDER NUMBER