Healthcare Provider Details

I. General information

NPI: 1245230192
Provider Name (Legal Business Name): EAST CARBON CITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2005
Last Update Date: 06/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 WEST GENEVA DRIVE
EAST CARBON UT
84520-0070
US

IV. Provider business mailing address

PO BOX 70 101 WEST GENEVA DRIVE
EAST CARBON UT
84520-0070
US

V. Phone/Fax

Practice location:
  • Phone: 435-650-0299
  • Fax: 435-888-0409
Mailing address:
  • Phone: 435-650-0299
  • Fax: 435-888-0409

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number0401L
License Number StateUT

VIII. Authorized Official

Name: BARBARA ROBINETT
Title or Position: EMS COORDINATOR
Credential:
Phone: 435-650-0299