| Organization Name: | ORTHO MEDICAL SUPPLY INC |
| NPI Number: | 1164844791 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MIKE VAN JENSEN (PRESIDENT) |
| Mailing Address: | 3480 Washington Blvd Ste 107 Ogden |
| State: | UT US |
| Postal Code: | 844014152 |
| Phone Number: | 8015287350 |
| Fax Number: | 8015287355 |
| NPI Enumeration Date: | 01/16/2014 |
| NPI Last Update Date: | 01/16/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 332B00000X |
| License Number: | 13746360-004-STC |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | UT |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient |