Basic Information
| Provider Information | |||||||||
| NPI: | 1225170442 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | AVALON ANCILLARY SERVICES,L.L.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 255 E 400 S | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | SALT LAKE CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841112846 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8013250157 | ||||||||
| FaxNumber: | 8015969001 | ||||||||
| Practice Location | |||||||||
| Address1: | 255 E 400 S | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | SALT LAKE CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841112846 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8013250157 | ||||||||
| FaxNumber: | 8015969001 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/13/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | BELL | ||||||||
| AuthorizedOfficialFirstName: | COREY | ||||||||
| AuthorizedOfficialMiddleName: | GEORGE | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT CEO BRIGHTON HC SERVICES | ||||||||
| AuthorizedOfficialTelephone: | 8013250157 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
No ID Information.