Healthcare Provider Details

I. General information

NPI: 1114073251
Provider Name (Legal Business Name): COUNTY OF WAYNE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 05/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 SOUTH MAIN
LOA UT
84747-0012
US

IV. Provider business mailing address

18 SOUTH MAIN PO BOX 12
LOA UT
84747-0012
US

V. Phone/Fax

Practice location:
  • Phone: 435-836-1348
  • Fax:
Mailing address:
  • Phone: 435-836-1348
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number2801L
License Number StateUT

VIII. Authorized Official

Name: MRS. JEANNIE WEBSTER
Title or Position: EMS COORDINATOR
Credential:
Phone: 435-836-1348