Provider Demographics
NPI:1922031533
Name:UTE INDIAN TRIBE
Entity Type:Organization
Organization Name:UTE INDIAN TRIBE
Other - Org Name:UTE TRIBE AMBULANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EMS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:J
Authorized Official - Last Name:BURT
Authorized Official - Suffix:
Authorized Official - Credentials:EMTI
Authorized Official - Phone:435-722-2286
Mailing Address - Street 1:PO BOX 876
Mailing Address - Street 2:
Mailing Address - City:PRICE
Mailing Address - State:UT
Mailing Address - Zip Code:84501-0876
Mailing Address - Country:US
Mailing Address - Phone:888-834-5032
Mailing Address - Fax:435-613-9414
Practice Address - Street 1:EAST HIGHWAY 40
Practice Address - Street 2:
Practice Address - City:FT DUSCHESNE
Practice Address - State:UT
Practice Address - Zip Code:84026
Practice Address - Country:US
Practice Address - Phone:435-572-2228
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1922031533Medicaid
UT000009025Medicare PIN