Provider Demographics
NPI:1447632013
Name:PLATINUM VENTURE GROUP LLC
Entity type:Organization
Organization Name:PLATINUM VENTURE GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VALREEN
Authorized Official - Middle Name:WILLNA
Authorized Official - Last Name:JOHN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-214-9918
Mailing Address - Street 1:8522 S 1300 E STE 103
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84094-1391
Mailing Address - Country:US
Mailing Address - Phone:801-214-9918
Mailing Address - Fax:385-533-5007
Practice Address - Street 1:8522 S 1300 E STE 103
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84094-1391
Practice Address - Country:US
Practice Address - Phone:801-214-9918
Practice Address - Fax:385-533-5007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-19
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies