Provider Demographics
NPI:1205931961
Name:MEDSTAR HOME MEDICAL, LLC.
Entity type:Organization
Organization Name:MEDSTAR HOME MEDICAL, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:S
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-768-4464
Mailing Address - Street 1:PO BOX 475
Mailing Address - Street 2:
Mailing Address - City:PLEASANT GROVE
Mailing Address - State:UT
Mailing Address - Zip Code:84062-0475
Mailing Address - Country:US
Mailing Address - Phone:801-768-4464
Mailing Address - Fax:801-766-3773
Practice Address - Street 1:405 N 880 W STE B
Practice Address - Street 2:
Practice Address - City:LINDON
Practice Address - State:UT
Practice Address - Zip Code:84042-1104
Practice Address - Country:US
Practice Address - Phone:801-768-4464
Practice Address - Fax:801-766-3773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2018-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
3983750001Medicare NSC