NPIMap

Organization Active NPI

Carols Personal Mastectomy Boutique

  • Durable Medical Equipment & Medical Supplies
  • Salt Lake City, UT
National Provider Identifier
1356522304
Registry record updated Nov 28, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
License
1744P3200X Issued in UT
Legal business name
CAROLS PERSONAL MASTECTOMY BOUTIQUE
Practice address
3165 S Main St
Salt Lake City, UT 84115-3748
Phone
(801) 483-1262
Fax
(801) 483-1287
NPI assigned
Nov 19, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 28, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Gary R Stenquist
Title
Owner
Phone
(801) 483-1262

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X 1744P3200X UT Primary

Addresses

Primary practice location

3165 S Main St
Salt Lake City, UT 84115-3748

Mailing address

3165 S Main St
Salt Lake City, UT 84115-3748
Phone (801) 483-1262

National Provider Directory

National Provider Directory

Locations

3165 S Main St
South Salt Lake, UT 84115
Phone (801) 483-1262

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1195430400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1322438400000",
    "number": "1356522304",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3165 S MAIN ST",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841153748",
            "telephone_number": "801-483-1262",
            "fax_number": "801-483-1287"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3165 S MAIN ST",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841153748",
            "telephone_number": "801-483-1262",
            "fax_number": "801-483-1287"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAROLS PERSONAL MASTECTOMY BOUTIQUE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-19",
        "last_updated": "2011-11-28",
        "status": "A",
        "authorized_official_last_name": "STENQUIST",
        "authorized_official_first_name": "GARY",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "801-483-1262"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "UT",
            "license": "1744P3200X",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Salt Lake City, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 28, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.