OrganizationActive
Bonfire Revenue
NPI 1548032568 · Clinic/Center · Murray, UT
Provider details
- NPI number
- 1548032568
- Entity type
- Organization
- Primary specialty
- Clinic/CenterAmbulatory Health Care Facilities
- Organization subpart
- No
- Authorized official
- Preston Boutsis, Cmo(877) 647-2455
Specialties & taxonomies
Ambulatory Health Care Facilities
Suppliers
Practice location
5547 S Walden Glen Dr
Murray, UT 84123-7942
Phone: (877) 647-2455
Approximate (ZIP-level) locationGet directions
Mailing address
8977 S 1300 W # 2046
West Jordan, UT 84088-9274
Registry dates
- Enumerated
- 2023-10-24
- Last updated
- 2023-10-24
- Certified
- 2023-10-24
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.