Provider Demographics
NPI:1346311164
Name:UINTA COUNTY AMBULANCE SERVICE
Entity Type:Organization
Organization Name:UINTA COUNTY AMBULANCE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF ADMINISTRATIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:A
Authorized Official - Last Name:QUINNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-789-8556
Mailing Address - Street 1:PO BOX 640
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:WY
Mailing Address - Zip Code:82931-0640
Mailing Address - Country:US
Mailing Address - Phone:307-789-8556
Mailing Address - Fax:307-789-4636
Practice Address - Street 1:1136 FRONT ST
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:WY
Practice Address - Zip Code:82930-3370
Practice Address - Country:US
Practice Address - Phone:307-789-8556
Practice Address - Fax:307-789-4636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY1163416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY7708OtherBLUE CROSS BLUE SHIELD WY
WY7708OtherBLUE CROSS BLUE SHIELD WY
WYW306974Medicare ID - Type UnspecifiedNORIDIAN MEDICARE