Provider Demographics
NPI:1194863936
Name:FREMONT COUNTY EMERGENCY PHYSICIANS PC
Entity Type:Organization
Organization Name:FREMONT COUNTY EMERGENCY PHYSICIANS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:NORTH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:801-423-3306
Mailing Address - Street 1:PO BOX 1276
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:UT
Mailing Address - Zip Code:84653-1276
Mailing Address - Country:US
Mailing Address - Phone:801-423-3306
Mailing Address - Fax:801-423-3309
Practice Address - Street 1:2100 W SUNSET DR
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:WY
Practice Address - Zip Code:82501-2274
Practice Address - Country:US
Practice Address - Phone:801-423-3306
Practice Address - Fax:801-423-3309
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes146D00000XEmergency Medical Service ProvidersPersonal Emergency Response AttendantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WYW21494Medicare UPIN