Provider Demographics
NPI:1902329469
Name:MEDALLUS & VACHAROTHONE LTD
Entity Type:Organization
Organization Name:MEDALLUS & VACHAROTHONE LTD
Other - Org Name:MEDALLUS MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:RACHOT
Authorized Official - Middle Name:K
Authorized Official - Last Name:VACHAROTHONE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-501-0500
Mailing Address - Street 1:PO BOX 95970
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-0970
Mailing Address - Country:US
Mailing Address - Phone:800-877-9236
Mailing Address - Fax:801-352-7976
Practice Address - Street 1:1501 LAMOILLE HWY
Practice Address - Street 2:
Practice Address - City:ELKO
Practice Address - State:NV
Practice Address - Zip Code:89801-4321
Practice Address - Country:US
Practice Address - Phone:775-400-1510
Practice Address - Fax:775-984-5170
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-17
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Multi-Specialty