Healthcare Provider Details

I. General information

NPI: 1588403661
Provider Name (Legal Business Name): FLAMING GORGE FIRE AND EMS DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2024
Last Update Date: 05/20/2024
Certification Date: 05/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

71 W 1ST N
MANILA UT
84046-4689
US

IV. Provider business mailing address

PO BOX 334
MANILA UT
84046-0334
US

V. Phone/Fax

Practice location:
  • Phone: 435-784-3255
  • Fax:
Mailing address:
  • Phone: 435-784-3255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: CASEY OLSEN
Title or Position: DIRECTOR OF EMS
Credential:
Phone: 435-778-3310