Provider Demographics
NPI:1053379172
Name:ORBIT MEDICAL INC
Entity type:Organization
Organization Name:ORBIT MEDICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:
Authorized Official - Last Name:BLISS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-713-2020
Mailing Address - Street 1:332 E 3300 S
Mailing Address - Street 2:STE 200
Mailing Address - City:SOUTH SALT LAKE
Mailing Address - State:UT
Mailing Address - Zip Code:84115-4456
Mailing Address - Country:US
Mailing Address - Phone:801-713-2020
Mailing Address - Fax:
Practice Address - Street 1:332 E 3300 S
Practice Address - Street 2:STE 200
Practice Address - City:SOUTH SALT LAKE
Practice Address - State:UT
Practice Address - Zip Code:84115-4111
Practice Address - Country:US
Practice Address - Phone:801-713-2020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-01
Last Update Date:2017-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UTJ05892332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2745711Medicaid
IL=========002Medicaid
OH2745711Medicaid
LA1780553Medicaid
NV100513019Medicaid
MI874763651Medicaid
SCDM1274Medicaid
IL=========002Medicaid
UT5300170001Medicare NSC
SCDM1274Medicaid