Provider Demographics
NPI:1881744951
Name:DR. DARRELL L OSTERHOUDT & ASSOCIATES PC
Entity type:Organization
Organization Name:DR. DARRELL L OSTERHOUDT & ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHELTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-568-0172
Mailing Address - Street 1:9217 REDWOOD RD STE C
Mailing Address - Street 2:
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84088-5827
Mailing Address - Country:US
Mailing Address - Phone:801-568-0172
Mailing Address - Fax:801-568-3932
Practice Address - Street 1:9217 REDWOOD RD STE C
Practice Address - Street 2:
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84088-5827
Practice Address - Country:US
Practice Address - Phone:801-568-0172
Practice Address - Fax:801-568-3932
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2018-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty