Provider Demographics
NPI:1467473116
Name:CITY OF ENTERPRISE AMBULANCE
Entity Type:Organization
Organization Name:CITY OF ENTERPRISE AMBULANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AMBULANCE BILLING CLERK
Authorized Official - Prefix:MRS
Authorized Official - First Name:JULENE
Authorized Official - Middle Name:
Authorized Official - Last Name:STREET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-878-2221
Mailing Address - Street 1:P.O. BOX 340
Mailing Address - Street 2:
Mailing Address - City:ENTERPRISE
Mailing Address - State:UT
Mailing Address - Zip Code:84725-0340
Mailing Address - Country:US
Mailing Address - Phone:435-878-2221
Mailing Address - Fax:435-878-2311
Practice Address - Street 1:375 S. 200 E.
Practice Address - Street 2:
Practice Address - City:ENTERPRISE
Practice Address - State:UT
Practice Address - Zip Code:84725
Practice Address - Country:US
Practice Address - Phone:435-878-2221
Practice Address - Fax:435-878-2311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2010-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2701L3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT=========00001OtherBLUE CROSS
UT=========007Medicaid
UT=========00001OtherBLUE CROSS