Healthcare Provider Details

I. General information

NPI: 1497943351
Provider Name (Legal Business Name): MAPLETON CITY CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2007
Last Update Date: 11/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 E MAPLE ST
MAPLETON UT
84664-4602
US

IV. Provider business mailing address

125 W COMMUNITY CENTER WAY
MAPLETON UT
84664
US

V. Phone/Fax

Practice location:
  • Phone: 801-491-8048
  • Fax:
Mailing address:
  • Phone: 801-298-4747
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number2518L
License Number StateUT

VII. Legacy identifiers

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

VIII. Authorized Official

Name: DEAN L PETTERSSON
Title or Position: CHIEF
Credential:
Phone: 801-491-8048