MEDICARE: CITY OF ENTERPRISE AMBULANCE

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	2701L	UT

General Provider Information

NPI Number	:	1467473116
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CITY OF ENTERPRISE AMBULANCE

Provider Business Mailing Address
First Line	:	P.O. BOX 340
Second Line	:
City	:	ENTERPRISE
State	:	UT
Zip	:	84725-0340
Country	:	US
Telephone Number	:	435-878-2221
Fax Number	:	435-878-2311

Provider Business Practice Location Address
First Line	:	375 S. 200 E.
Second Line	:
City	:	ENTERPRISE
State	:	UT
Zip	:	84725
Country	:	US
Telephone Number	:	435-878-2221
Fax Number	:	435-878-2311

Authorized Official
Title or Position	:	AMBULANCE BILLING CLERK
Name	:	MRS. JULENE STREET
Credential	:
Telephone Number	:	435-878-2221

Provider Enumeration Date	:	07/21/2006
Last Update Date	:	02/26/2010

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Directions to “CITY OF ENTERPRISE AMBULANCE ” Practice Location

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