Provider Demographics
NPI:1790931061
Name:AMBULANCE SERVICES OF TOOELE, LLC
Entity Type:Organization
Organization Name:AMBULANCE SERVICES OF TOOELE, LLC
Other - Org Name:MOUNTAIN WEST AMBULANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR, CLINIC REVENUE CYCLE
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:J
Authorized Official - Last Name:FEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-221-3641
Mailing Address - Street 1:2055 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:TOOELE
Mailing Address - State:UT
Mailing Address - Zip Code:84074-9819
Mailing Address - Country:US
Mailing Address - Phone:435-843-8745
Mailing Address - Fax:
Practice Address - Street 1:153 S MAIN ST
Practice Address - Street 2:
Practice Address - City:TOOELE
Practice Address - State:UT
Practice Address - Zip Code:84074-2127
Practice Address - Country:US
Practice Address - Phone:435-884-0913
Practice Address - Fax:435-884-6208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-18
Last Update Date:2019-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT20062233416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT23200000000001OtherREGENCE BLUE CROSS
UT1790931061Medicaid
UT1790931061Medicaid