Provider Demographics
NPI:1235136235
Name:PLEASANT GROVE CITY CORPORATION
Entity Type:Organization
Organization Name:PLEASANT GROVE CITY CORPORATION
Other - Org Name:PLEASANT GROVE CITY AMBULANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING CLERK
Authorized Official - Prefix:MRS
Authorized Official - First Name:MOLLY
Authorized Official - Middle Name:JUNE
Authorized Official - Last Name:PURDIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-785-5045
Mailing Address - Street 1:70 S 100 E
Mailing Address - Street 2:
Mailing Address - City:PLEASANT GROVE
Mailing Address - State:UT
Mailing Address - Zip Code:84062-2702
Mailing Address - Country:US
Mailing Address - Phone:801-785-5045
Mailing Address - Fax:801-785-8925
Practice Address - Street 1:70 S 100 E
Practice Address - Street 2:
Practice Address - City:PLEASANT GROVE
Practice Address - State:UT
Practice Address - Zip Code:84062-2702
Practice Address - Country:US
Practice Address - Phone:801-785-5045
Practice Address - Fax:801-785-8925
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-05
Last Update Date:2010-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2504L3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport