Provider Demographics
NPI:1114731882
Name:EAGLE HEALTH SERVICES LLC
Entity type:Organization
Organization Name:EAGLE HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:TANGINA
Authorized Official - Middle Name:
Authorized Official - Last Name:MALOOF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-636-5055
Mailing Address - Street 1:1213 FLINT MEADOW DR STE 1C
Mailing Address - Street 2:
Mailing Address - City:KAYSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84037-6833
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1351 W PINE AVE STE B
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-2010
Practice Address - Country:US
Practice Address - Phone:385-420-7500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-04
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment