Provider Demographics
NPI:1912649609
Name:NORTHERN UTAH MEDICAL SUPPLY LLC
Entity Type:Organization
Organization Name:NORTHERN UTAH MEDICAL SUPPLY LLC
Other - Org Name:HP MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:BRUCE
Authorized Official - Last Name:PUGSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:435-787-2000
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:801-505-0821
Mailing Address - Fax:801-505-0803
Practice Address - Street 1:1030 S MEDICAL DR STE A
Practice Address - Street 2:
Practice Address - City:BRIGHAM CITY
Practice Address - State:UT
Practice Address - Zip Code:84302-3281
Practice Address - Country:US
Practice Address - Phone:435-723-9700
Practice Address - Fax:435-723-9710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-12
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty