Provider Demographics
NPI:1912638719
Name:ALTA MEDICAL SUPPLY LLC
Entity Type:Organization
Organization Name:ALTA MEDICAL SUPPLY LLC
Other - Org Name:ALTA MEDICAL SUPPLY LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:
Authorized Official - Last Name:JONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-505-0821
Mailing Address - Street 1:280 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84010-6236
Mailing Address - Country:US
Mailing Address - Phone:801-505-0820
Mailing Address - Fax:801-505-0802
Practice Address - Street 1:280 S MAIN ST
Practice Address - Street 2:
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-6236
Practice Address - Country:US
Practice Address - Phone:801-505-0820
Practice Address - Fax:801-505-0802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-22
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies