Healthcare Provider Details

I. General information

NPI: 1568553089
Provider Name (Legal Business Name): MANTI AMBULANCE ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 12/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 W 200 N
MANTI UT
84642
US

IV. Provider business mailing address

50 S MAIN ST
MANTI UT
84642-1372
US

V. Phone/Fax

Practice location:
  • Phone: 435-835-4630
  • Fax:
Mailing address:
  • Phone: 435-835-4631
  • Fax: 435-835-2632

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State

VIII. Authorized Official

Name: MS. MICHELLE FRANCKS
Title or Position: SECRETARY/TREASURER
Credential:
Phone: 435-835-4631