Provider Demographics
NPI:1134621550
Name:PEGASUS LIFTS NORTHERN UTAH, LLC
Entity type:Organization
Organization Name:PEGASUS LIFTS NORTHERN UTAH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:
Authorized Official - Last Name:BRINKERHOFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-695-7042
Mailing Address - Street 1:1361 N 1075 W STE 10
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:UT
Mailing Address - Zip Code:84025-2876
Mailing Address - Country:US
Mailing Address - Phone:801-695-7042
Mailing Address - Fax:
Practice Address - Street 1:1361 N 1075 W STE 10
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:UT
Practice Address - Zip Code:84025-2876
Practice Address - Country:US
Practice Address - Phone:801-695-7042
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-01
Last Update Date:2018-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)