Provider Demographics
NPI:1245385814
Name:COUNTY OF EMERY
Entity Type:Organization
Organization Name:COUNTY OF EMERY
Other - Org Name:EMERY COUNTY AMBULANCE SERVICE
Other - Org Type:Other Name
Authorized Official - Title/Position:COUNTY CLERK
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:TUTTLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-381-5106
Mailing Address - Street 1:PO BOX 907
Mailing Address - Street 2:
Mailing Address - City:CASTLE DALE
Mailing Address - State:UT
Mailing Address - Zip Code:84513-0907
Mailing Address - Country:US
Mailing Address - Phone:435-381-5106
Mailing Address - Fax:435-381-5183
Practice Address - Street 1:95 E MAIN
Practice Address - Street 2:
Practice Address - City:CASTLE DALE
Practice Address - State:UT
Practice Address - Zip Code:84513
Practice Address - Country:US
Practice Address - Phone:435-381-2200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2018-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT0801L3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT=========000Medicaid
UT=========000Medicaid