Healthcare Provider Details

I. General information

NPI: 1881858660
Provider Name (Legal Business Name): BLUFFDALE CITY CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2008
Last Update Date: 09/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14350 S 2200 W
BLUFFDALE UT
84065-5328
US

IV. Provider business mailing address

14350 SOUTH 2200 WEST
BLUFFDALE UT
84065
US

V. Phone/Fax

Practice location:
  • Phone: 801-254-2200
  • Fax: 801-253-3270
Mailing address:
  • Phone: 801-254-2200
  • Fax: 801-253-3270

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number1869L
License Number StateUT

VIII. Authorized Official

Name: MS. MARSHA V BLACK
Title or Position: PRESIDENT
Credential: CPC
Phone: 801-295-9886