Provider Demographics
NPI:1912936865
Name:REHAB MEDICAL OF SALT LAKE, LLC
Entity Type:Organization
Organization Name:REHAB MEDICAL OF SALT LAKE, LLC
Other - Org Name:FIRST CHOICE MEDICAL SUPPLY, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:MCGINLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-813-0205
Mailing Address - Street 1:3750 PRIORITY WAY SOUTH DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46240-3831
Mailing Address - Country:US
Mailing Address - Phone:801-713-4187
Mailing Address - Fax:866-566-4257
Practice Address - Street 1:3690 S 500 W
Practice Address - Street 2:SUITE 104
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84115
Practice Address - Country:US
Practice Address - Phone:801-713-4187
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
UT000214332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
5858760001Medicare NSC