Provider Demographics
NPI:1982885422
Name:STEVENSONS INC
Entity Type:Organization
Organization Name:STEVENSONS INC
Other - Org Name:COMFORT FOOTWEAR & PEDORTHIC SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:D
Authorized Official - Last Name:WENGREN
Authorized Official - Suffix:
Authorized Official - Credentials:CPED
Authorized Official - Phone:801-466-2884
Mailing Address - Street 1:620 EAST WILMINGTON AVE.
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84106-1421
Mailing Address - Country:US
Mailing Address - Phone:801-466-2884
Mailing Address - Fax:801-466-2884
Practice Address - Street 1:620 EAST WILMINGTON AVE
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84106-1421
Practice Address - Country:US
Practice Address - Phone:801-466-2884
Practice Address - Fax:801-466-2884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-26
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT4681840001Medicare NSC