Provider Demographics
NPI:1023196060
Name:NORTH FORK SPECIAL SERVICE DIST
Entity Type:Organization
Organization Name:NORTH FORK SPECIAL SERVICE DIST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:COREY
Authorized Official - Middle Name:
Authorized Official - Last Name:CLUFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-225-7263
Mailing Address - Street 1:RR 3 BOX B1
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-8902
Mailing Address - Country:US
Mailing Address - Phone:801-225-7263
Mailing Address - Fax:
Practice Address - Street 1:8838 N ALPINE LOOP RD
Practice Address - Street 2:
Practice Address - City:SUNDANCE
Practice Address - State:UT
Practice Address - Zip Code:84604-5538
Practice Address - Country:US
Practice Address - Phone:801-225-7263
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2016-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance