Provider Demographics
NPI:1932285954
Name:AFFINITY MEDICAL GROUP INC.
Entity Type:Organization
Organization Name:AFFINITY MEDICAL GROUP INC.
Other - Org Name:AFFINITY MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:E
Authorized Official - Last Name:BOYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-262-7700
Mailing Address - Street 1:395 IRONWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84115-2912
Mailing Address - Country:US
Mailing Address - Phone:801-262-7700
Mailing Address - Fax:801-262-7707
Practice Address - Street 1:395 IRONWOOD DR
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84115-2912
Practice Address - Country:US
Practice Address - Phone:801-262-7700
Practice Address - Fax:801-262-7707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-31
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12026218-002-STC332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT5827090001Medicare NSC