Provider Demographics
NPI:1225285299
Name:RIVERDALE CITY UTAH
Entity Type:Organization
Organization Name:RIVERDALE CITY UTAH
Other - Org Name:RIVERDALE CITY CORPORATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CAPTAIN
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:G
Authorized Official - Last Name:HENNESSY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-394-7481
Mailing Address - Street 1:4334 PARKER DR
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:UT
Mailing Address - Zip Code:84405-3340
Mailing Address - Country:US
Mailing Address - Phone:801-394-7481
Mailing Address - Fax:801-621-6150
Practice Address - Street 1:4334 PARKER DR
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:UT
Practice Address - Zip Code:84405-3340
Practice Address - Country:US
Practice Address - Phone:801-394-7481
Practice Address - Fax:801-621-6150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-21
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTP00759219OtherRAILROAD MEDICARE