Provider Demographics
NPI:1720054828
Name:MOUNTAIN VALLEY HOME MEDICAL EQUIPMENT, INC.
Entity type:Organization
Organization Name:MOUNTAIN VALLEY HOME MEDICAL EQUIPMENT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KURT
Authorized Official - Middle Name:W
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-282-6922
Mailing Address - Street 1:9050 S 300 W
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84070-2757
Mailing Address - Country:US
Mailing Address - Phone:801-282-6922
Mailing Address - Fax:801-282-6925
Practice Address - Street 1:9050 S 300 W
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84070-2757
Practice Address - Country:US
Practice Address - Phone:801-282-6922
Practice Address - Fax:801-282-6925
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-27
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT60321381714332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT=========006Medicaid
UT4443180002Medicare NSC