Healthcare Provider Details

I. General information

NPI: 1053400242
Provider Name (Legal Business Name): COUNTY OF DAGGETT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 N 1ST WEST
MANILA UT
84046
US

IV. Provider business mailing address

PO BOX 387
MANILA UT
84046-0387
US

V. Phone/Fax

Practice location:
  • Phone: 435-784-3222
  • Fax: 435-784-3335
Mailing address:
  • Phone: 435-784-3222
  • Fax: 435-784-3335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number0501L
License Number StateUT

VIII. Authorized Official

Name: MR. STEWART LEITH
Title or Position: COMMISSIONER
Credential:
Phone: 14357843222