1144259805 NPI number — COUNTY OF SUMMIT

Table of content: (NPI 1144259805)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144259805 NPI number — COUNTY OF SUMMIT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COUNTY OF SUMMIT
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SOUTH SUMMIT AMBULANCE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1144259805
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/06/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 95970
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOUTH JORDAN
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84095-0970
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-352-9500
Provider Business Mailing Address Fax Number:
801-352-9502

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
210 EAST 400 SOUTH
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KAMAS
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84036-0266
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
435-783-6276
Provider Business Practice Location Address Fax Number:
435-783-6277
Provider Enumeration Date:
07/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FRAZIER
Authorized Official First Name:
BLAKE
Authorized Official Middle Name:
L
Authorized Official Title or Position:
AUDITOR
Authorized Official Telephone Number:
435-336-3254

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1144259805 , issued by the state of ( UT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 590011561 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".




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