Bonfire Revenue

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

BONFIRE REVENUE

Practice address

5547 S Walden Glen Dr
Murray, UT 84123-7942

Phone

(877) 647-2455

NPI assigned

Oct 24, 2023

Organization subpart

No

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

Authorized official

Name

Preston Boutsis

Title

Cmo

Phone

(877) 647-2455

Specialties & licenses 2

Addresses

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

{
    "created_epoch": "1698105600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1698105600000",
    "number": "1548032568",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8977 S 1300 W # 2046",
            "city": "WEST JORDAN",
            "state": "UT",
            "postal_code": "840889274"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5547 S WALDEN GLEN DR",
            "city": "MURRAY",
            "state": "UT",
            "postal_code": "841237942",
            "telephone_number": "877-647-2455"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BONFIRE REVENUE",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-10-24",
        "last_updated": "2023-10-24",
        "certification_date": "2023-10-24",
        "status": "A",
        "authorized_official_last_name": "BOUTSIS",
        "authorized_official_first_name": "PRESTON",
        "authorized_official_title_or_position": "CMO",
        "authorized_official_telephone_number": "877-647-2455"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Markus A. Boesl, MD
• James Bokinskie II, DPT
• Jordan Bolinder
• Bruce A. Bolonesi, PA-C
• Sherri Boltz
• Emily Marie Bonham, MS
• Austin Booth
• Dustin Lee Boothe, MD
• Ana Lia Borges de Martinez
• Luanne Fakler Borgmeier, OTR

• Clinic/Center in Murray, UT
• Providers in Murray, UT by specialty
• Clinic/Center in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2023; 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.