Provider Demographics
NPI: | 1194050237 |
---|---|
Name: | LITTLEFIELD COMPANY |
Entity type: | Organization |
Organization Name: | LITTLEFIELD COMPANY |
Other - Org Name: | <UNAVAIL> |
Other - Org Type: | |
Authorized Official - Title/Position: | SECTREAS |
Authorized Official - Prefix: | MR |
Authorized Official - First Name: | MICHAEL |
Authorized Official - Middle Name: | S |
Authorized Official - Last Name: | LITTLEFIELD |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | HEARING INSTRUMENT S |
Authorized Official - Phone: | 801-485-1441 |
Mailing Address - Street 1: | 1441 E 2100 S |
Mailing Address - Street 2: | |
Mailing Address - City: | SALT LAKE CITY |
Mailing Address - State: | UT |
Mailing Address - Zip Code: | 84105-3724 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 801-485-1441 |
Mailing Address - Fax: | 801-485-1480 |
Practice Address - Street 1: | 1441 E 2100 S |
Practice Address - Street 2: | |
Practice Address - City: | SALT LAKE CITY |
Practice Address - State: | UT |
Practice Address - Zip Code: | 84105-3724 |
Practice Address - Country: | US |
Practice Address - Phone: | 801-485-1441 |
Practice Address - Fax: | 801-485-1480 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2009-10-07 |
Last Update Date: | 2009-10-07 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 332S00000X | Suppliers | Hearing Aid Equipment |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
UT | =========003 | Medicaid |