Provider Demographics
NPI:1801299714
Name:MEDVANTAGE, LLC
Entity type:Organization
Organization Name:MEDVANTAGE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DARIN
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:JOHNCOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-430-0149
Mailing Address - Street 1:2164 S RICHARDS ST
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84115-2606
Mailing Address - Country:US
Mailing Address - Phone:888-412-8087
Mailing Address - Fax:888-522-0355
Practice Address - Street 1:2164 S RICHARDS ST
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84115-2606
Practice Address - Country:US
Practice Address - Phone:888-412-8087
Practice Address - Fax:888-522-0355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-06
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10000250003332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies