Carols Mastectomy Shope

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

License

003872 Issued in UT

Legal business name

CAROLS MASTECTOMY SHOPE

Practice address

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

Phone

(801) 483-1262

Fax

(801) 483-1287

NPI assigned

Sep 16, 2013

Organization subpart

No

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

Authorized official

Name

Mrs. Shellie Stenquist

Title

Owner/ Manager

Phone

(801) 483-1262

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in UT

Enrollment records 1

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

{
    "created_epoch": "1379289600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1390780800000",
    "number": "1801222401",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3165 S MAIN ST",
            "city": "S SALT LAKE",
            "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": "S SALT LAKE",
            "state": "UT",
            "postal_code": "841153748",
            "telephone_number": "801-483-1262",
            "fax_number": "801-483-1287"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAROLS MASTECTOMY SHOPE",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-09-16",
        "last_updated": "2014-01-27",
        "status": "A",
        "authorized_official_last_name": "STENQUIST",
        "authorized_official_first_name": "SHELLIE",
        "authorized_official_title_or_position": "OWNER/ MANAGER",
        "authorized_official_telephone_number": "801-483-1262",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "UT",
            "license": "003872",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• John Adolf Bach, D.C.
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• Carla Huffstetler, MFT
• Johanna Care Center, Inc.
• Kan-Di-Ki LLC

• Durable Medical Equipment & Medical Supplies in S Salt Lake, UT
• Providers in S Salt Lake, UT by specialty
• Durable Medical Equipment & Medical Supplies in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.