Provider Demographics
NPI:1881946051
Name:OXYGEN UTAH
Entity type:Organization
Organization Name:OXYGEN UTAH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JONAS
Authorized Official - Middle Name:THEODORE
Authorized Official - Last Name:WILKINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-417-8099
Mailing Address - Street 1:3587 W 4700 S
Mailing Address - Street 2:
Mailing Address - City:TAYLORSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84129-2846
Mailing Address - Country:US
Mailing Address - Phone:801-417-8099
Mailing Address - Fax:801-417-8078
Practice Address - Street 1:3587 W 4700 S
Practice Address - Street 2:
Practice Address - City:TAYLORSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84129-2846
Practice Address - Country:US
Practice Address - Phone:801-417-8099
Practice Address - Fax:801-417-8078
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-11
Last Update Date:2013-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7906715-1710332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
6730610001Medicare NSC