Provider Demographics
NPI:1205985272
Name:SPANISH FORK CITY CORPORATION
Entity type:Organization
Organization Name:SPANISH FORK CITY CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PUBLIC SAFETY SUPERVISOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DON
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-798-5077
Mailing Address - Street 1:40 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SPANISH FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84660-2031
Mailing Address - Country:US
Mailing Address - Phone:801-798-5000
Mailing Address - Fax:801-798-5005
Practice Address - Street 1:40 S MAIN ST
Practice Address - Street 2:
Practice Address - City:SPANISH FORK
Practice Address - State:UT
Practice Address - Zip Code:84660-2031
Practice Address - Country:US
Practice Address - Phone:801-798-5000
Practice Address - Fax:801-798-5005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2013-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2509L3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT876002842005Medicaid
UT000009087Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER