Provider Demographics
NPI:1497943351
Name:MAPLETON CITY CORPORATION
Entity Type:Organization
Organization Name:MAPLETON CITY CORPORATION
Other - Org Name:MAPLETON CITY AMBULANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:PETTERSSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-491-8048
Mailing Address - Street 1:125 W COMMUNITY CENTER WAY
Mailing Address - Street 2:
Mailing Address - City:MAPLETON
Mailing Address - State:UT
Mailing Address - Zip Code:84664
Mailing Address - Country:US
Mailing Address - Phone:801-298-4747
Mailing Address - Fax:
Practice Address - Street 1:35 E MAPLE ST
Practice Address - Street 2:
Practice Address - City:MAPLETON
Practice Address - State:UT
Practice Address - Zip Code:84664-4602
Practice Address - Country:US
Practice Address - Phone:801-491-8048
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-04
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2518L3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000009050Medicare PIN