Provider Demographics
NPI:1538884655
Name:UTAH IDEA BUILDER LLC
Entity type:Organization
Organization Name:UTAH IDEA BUILDER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CMO
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GRASSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-683-9191
Mailing Address - Street 1:1819 N MAIN ST UNIT 9
Mailing Address - Street 2:
Mailing Address - City:SPANISH FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84660-5538
Mailing Address - Country:US
Mailing Address - Phone:801-683-9191
Mailing Address - Fax:
Practice Address - Street 1:78 E 100 S
Practice Address - Street 2:
Practice Address - City:PAYSON
Practice Address - State:UT
Practice Address - Zip Code:84651-2262
Practice Address - Country:US
Practice Address - Phone:801-683-9191
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-11
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment