Healthcare Provider Details

I. General information

NPI: 1194771618
Provider Name (Legal Business Name): MIDVALE CITY CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 02/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

607 E 7200 S
MIDVALE UT
84047-2215
US

IV. Provider business mailing address

PO BOX 276
MIDVALE UT
84047-0276
US

V. Phone/Fax

Practice location:
  • Phone: 801-263-0810
  • Fax: 801-270-8170
Mailing address:
  • Phone: 801-263-0810
  • Fax: 801-270-8170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number1862L
License Number StateUT

VIII. Authorized Official

Name: DEBBIE ORTON
Title or Position: OFFICE MANAGER
Credential:
Phone: 801-263-0810