Provider Demographics
NPI:1104229665
Name:ELN ENTERPRISES
Entity type:Organization
Organization Name:ELN ENTERPRISES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:866-612-7449
Mailing Address - Street 1:1480 ORCHARD DR STE 103
Mailing Address - Street 2:
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84010-5172
Mailing Address - Country:US
Mailing Address - Phone:866-612-7449
Mailing Address - Fax:
Practice Address - Street 1:1480 ORCHARD DR STE 103
Practice Address - Street 2:
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-5172
Practice Address - Country:US
Practice Address - Phone:866-612-7449
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-09-29
Last Update Date:2014-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty