Provider Demographics
NPI:1932144383
Name:MDS MEDICAL DEVICE SPECIALTY, INC
Entity Type:Organization
Organization Name:MDS MEDICAL DEVICE SPECIALTY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:JOLLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-475-0303
Mailing Address - Street 1:270 W 500 N
Mailing Address - Street 2:
Mailing Address - City:NORTH SALT LAKE
Mailing Address - State:UT
Mailing Address - Zip Code:84054-2769
Mailing Address - Country:US
Mailing Address - Phone:801-475-0303
Mailing Address - Fax:888-455-8597
Practice Address - Street 1:270 W 500 N
Practice Address - Street 2:
Practice Address - City:NORTH SALT LAKE
Practice Address - State:UT
Practice Address - Zip Code:84054-2769
Practice Address - Country:US
Practice Address - Phone:801-475-0303
Practice Address - Fax:888-455-8597
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-19
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT5722790001Medicare NSC