Provider Demographics
NPI:1841559424
Name:PARTNER MEDICAL UT LLC
Entity Type:Organization
Organization Name:PARTNER MEDICAL UT LLC
Other - Org Name:PARTNER MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:D
Authorized Official - Last Name:SEVERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:605-275-0083
Mailing Address - Street 1:12393 GATEWAY PARK PL
Mailing Address - Street 2:SUITE 50
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-2309
Mailing Address - Country:US
Mailing Address - Phone:605-275-0083
Mailing Address - Fax:866-590-2137
Practice Address - Street 1:12393 GATEWAY PARK PL
Practice Address - Street 2:SUITE 50
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-2309
Practice Address - Country:US
Practice Address - Phone:605-275-0083
Practice Address - Fax:866-590-2137
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-16
Last Update Date:2014-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
6993960001Medicare NSC