Provider Demographics
NPI:1003986613
Name:CITY OF ROY CORP.
Entity Type:Organization
Organization Name:CITY OF ROY CORP.
Other - Org Name:ROY CITY AMBULANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DEPUTY CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:J
Authorized Official - Last Name:FROERER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-774-1080
Mailing Address - Street 1:5051 S 1900 W
Mailing Address - Street 2:
Mailing Address - City:ROY
Mailing Address - State:UT
Mailing Address - Zip Code:84067-2936
Mailing Address - Country:US
Mailing Address - Phone:801-774-1080
Mailing Address - Fax:801-774-1059
Practice Address - Street 1:5051 S 1900 W
Practice Address - Street 2:
Practice Address - City:ROY
Practice Address - State:UT
Practice Address - Zip Code:84067-2936
Practice Address - Country:US
Practice Address - Phone:801-774-1080
Practice Address - Fax:801-774-1059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2008-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2902L3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT990001909006Medicaid
UT000064295Medicare PIN
UT590157429Medicare PIN