Provider Demographics
NPI:1437414612
Name:SECLARK HOLDINGS, LLC DBA WASATCH MEDICAL SUPPLY
Entity type:Organization
Organization Name:SECLARK HOLDINGS, LLC DBA WASATCH MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-718-2755
Mailing Address - Street 1:1342 W 7800 S
Mailing Address - Street 2:
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84088-4100
Mailing Address - Country:US
Mailing Address - Phone:801-566-5844
Mailing Address - Fax:801-566-5605
Practice Address - Street 1:1342 W 7800 S
Practice Address - Street 2:
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84088-4100
Practice Address - Country:US
Practice Address - Phone:801-566-5844
Practice Address - Fax:801-566-5605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-12
Last Update Date:2012-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT27447332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies