Provider Demographics
NPI:1750430914
Name:FORWARD MOTION MEDICAL SYSTEMS INC
Entity type:Organization
Organization Name:FORWARD MOTION MEDICAL SYSTEMS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:KENNETH
Authorized Official - Last Name:BALLANTYNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-251-8506
Mailing Address - Street 1:615 N 3050 E
Mailing Address - Street 2:SUITE A6
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-8603
Mailing Address - Country:US
Mailing Address - Phone:435-251-8506
Mailing Address - Fax:435-251-8505
Practice Address - Street 1:615 N 3050 E
Practice Address - Street 2:SUITE A6
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-8603
Practice Address - Country:US
Practice Address - Phone:435-251-8506
Practice Address - Fax:435-251-8505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2020-08-22
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
UT4841220001Medicare ID - Type Unspecified