Provider Demographics
NPI:1811204779
Name:HEAD 2 TOE MEDICAL
Entity Type:Organization
Organization Name:HEAD 2 TOE MEDICAL
Other - Org Name:JAMES M WEBER
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:WEBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-717-7076
Mailing Address - Street 1:1089 N 1800 W
Mailing Address - Street 2:
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-3067
Mailing Address - Country:US
Mailing Address - Phone:801-717-7076
Mailing Address - Fax:209-370-9975
Practice Address - Street 1:1089 N 1800 W
Practice Address - Street 2:
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-3067
Practice Address - Country:US
Practice Address - Phone:801-717-7076
Practice Address - Fax:209-370-9975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-13
Last Update Date:2010-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT72556540142332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies