Provider Demographics
NPI:1578661708
Name:SOUTH DAVIS METRO FIRE AGENCY
Entity Type:Organization
Organization Name:SOUTH DAVIS METRO FIRE AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:NANNETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-677-2401
Mailing Address - Street 1:PO BOX 1547
Mailing Address - Street 2:
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84011-1547
Mailing Address - Country:US
Mailing Address - Phone:801-677-2400
Mailing Address - Fax:801-677-0166
Practice Address - Street 1:255 S 100 W
Practice Address - Street 2:
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-6273
Practice Address - Country:US
Practice Address - Phone:801-677-2400
Practice Address - Fax:801-677-0166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT0634L341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT=========001Medicaid