Provider Demographics
NPI:1568553089
Name:MANTI AMBULANCE ASSOCIATION
Entity Type:Organization
Organization Name:MANTI AMBULANCE ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY/TREASURER
Authorized Official - Prefix:MS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:FRANCKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-835-4631
Mailing Address - Street 1:50 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MANTI
Mailing Address - State:UT
Mailing Address - Zip Code:84642-1372
Mailing Address - Country:US
Mailing Address - Phone:435-835-4631
Mailing Address - Fax:435-835-2632
Practice Address - Street 1:33 W 200 N
Practice Address - Street 2:
Practice Address - City:MANTI
Practice Address - State:UT
Practice Address - Zip Code:84642
Practice Address - Country:US
Practice Address - Phone:435-835-4630
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2008-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT698070030001Medicaid
UT698070030001Medicaid