Provider Demographics
NPI:1366713711
Name:EAGLE MEDICAL LLC
Entity type:Organization
Organization Name:EAGLE MEDICAL LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:AARON
Authorized Official - Middle Name:
Authorized Official - Last Name:MELDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-889-2399
Mailing Address - Street 1:802 E WINCHESTER ST
Mailing Address - Street 2:STE 240
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-7580
Mailing Address - Country:US
Mailing Address - Phone:801-889-2399
Mailing Address - Fax:
Practice Address - Street 1:802 E WINCHESTER ST
Practice Address - Street 2:STE 240
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84107-7580
Practice Address - Country:US
Practice Address - Phone:801-889-2399
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-17
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8205424-0160332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1366713711OtherNPI