MEDICARE: PLYMOUTH TOWN CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3416L0300X	Land Ambulance	0205L	UT

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	U000073129	OTHER	UT	MEDICARE TYPE UNSPECIFIED

General Provider Information

NPI Number	:	1154334472
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PLYMOUTH TOWN CORPORATION

Provider Business Mailing Address
First Line	:	PO BOX 130
Second Line	:
City	:	PLYMOUTH
State	:	UT
Zip	:	84330-0130
Country	:	US
Telephone Number	:	435-239-7278
Fax Number	:

Provider Business Practice Location Address
First Line	:	20120 N 5200 W
Second Line	:
City	:	PLYMOUTH
State	:	UT
Zip	:	84330
Country	:	US
Telephone Number	:	435-239-7278
Fax Number	:

Authorized Official
Title or Position	:	CHIEF
Name	:	JERIMY R ANDERSON
Credential	:
Telephone Number	:	435-239-7278

Provider Enumeration Date	:	08/15/2006
Last Update Date	:	04/07/2011

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Directions to “PLYMOUTH TOWN CORPORATION ” Practice Location

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