Provider Demographics
NPI:1235326679
Name:SCIPIO TOWN CORPORATION
Entity Type:Organization
Organization Name:SCIPIO TOWN CORPORATION
Other - Org Name:SCIPIO AMBULANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TRAINING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:K
Authorized Official - Last Name:ROBISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-758-2411
Mailing Address - Street 1:160 NORTH STATE ST
Mailing Address - Street 2:
Mailing Address - City:SCIPIO
Mailing Address - State:UT
Mailing Address - Zip Code:84656-0063
Mailing Address - Country:US
Mailing Address - Phone:435-758-2411
Mailing Address - Fax:
Practice Address - Street 1:160 NORTH STATE STR
Practice Address - Street 2:
Practice Address - City:SCIPIO
Practice Address - State:UT
Practice Address - Zip Code:84656-0063
Practice Address - Country:US
Practice Address - Phone:435-758-2411
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-01
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1403L341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT=========005Medicaid
UT=========005Medicaid