Provider Demographics
NPI:1073634234
Name:DRAPER CITY
Entity Type:Organization
Organization Name:DRAPER CITY
Other - Org Name:DRAPER CITY AMBULANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:CLINT
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-824-3709
Mailing Address - Street 1:780 E 12300 S
Mailing Address - Street 2:
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-9571
Mailing Address - Country:US
Mailing Address - Phone:385-557-2801
Mailing Address - Fax:
Practice Address - Street 1:780 E 12300 S
Practice Address - Street 2:
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-9571
Practice Address - Country:US
Practice Address - Phone:385-557-2801
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1852L341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT590005840OtherPALMETTO GBA
UT590005840OtherRAILROAD MEDICARE
UT590005840OtherRAILROAD MEDICARE
UT000009035Medicare PIN
UT000009035Medicare PIN