| Bonfire Revenue | |
|
5547 S Walden Glen Dr Murray UT 84123-7942 | |
| (877) 647-2455 | |
| Not Available |
| Full Name | Bonfire Revenue |
|---|---|
| Speciality | Clinic/center |
| Location | 5547 S Walden Glen Dr, Murray, Utah |
| Authorized Official Name and Position | Preston Boutsis (CMO) |
| Authorized Official Contact | 8776472455 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Bonfire Revenue 8977 S 1300 W # 2046 West Jordan UT 84088-9274 | Bonfire Revenue 5547 S Walden Glen Dr Murray UT 84123-7942 Ph: (877) 647-2455 |
| NPI Number | 1548032568 |
|---|---|
| Provider Enumeration Date | 10/24/2023 |
| Last Update Date | 10/24/2023 |
| Certification Date | 10/24/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1548032568 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | () | Primary |
| 332B00000X | Durable Medical Equipment & Medical Supplies | () | Secondary |
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