Provider Demographics
NPI:1669452298
Name:CUSTOM MEDICAL SERVICES
Entity Type:Organization
Organization Name:CUSTOM MEDICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:EDWIN
Authorized Official - Last Name:PEHRSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:435-722-7704
Mailing Address - Street 1:RR 3 BOX 3053
Mailing Address - Street 2:
Mailing Address - City:ROOSEVELT
Mailing Address - State:UT
Mailing Address - Zip Code:84066-9609
Mailing Address - Country:US
Mailing Address - Phone:435-722-7704
Mailing Address - Fax:
Practice Address - Street 1:RR 3 BOX 3053
Practice Address - Street 2:
Practice Address - City:ROOSEVELT
Practice Address - State:UT
Practice Address - Zip Code:84066-9609
Practice Address - Country:US
Practice Address - Phone:435-722-7704
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UTV09531173000000X, 207QA0505X
207QA0000X, 207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered173000000XOther Service ProvidersLegal MedicineGroup - Multi-Specialty
Not Answered207QA0000XAllopathic & Osteopathic PhysiciansFamily MedicineAdolescent MedicineGroup - Multi-Specialty
Not Answered207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Multi-Specialty
Not Answered207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Multi-Specialty