Provider Demographics
NPI:1083433684
Name:LIVE TULA LLC
Entity type:Organization
Organization Name:LIVE TULA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CISO
Authorized Official - Prefix:
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:BROADHEAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:855-528-0773
Mailing Address - Street 1:686 N ARBINGER WAY STE 300
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:UT
Mailing Address - Zip Code:84025-3071
Mailing Address - Country:US
Mailing Address - Phone:855-528-0773
Mailing Address - Fax:
Practice Address - Street 1:686 N ARBINGER WAY STE 300
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:UT
Practice Address - Zip Code:84025-3071
Practice Address - Country:US
Practice Address - Phone:855-528-0773
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-09
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies