Healthcare Provider Details

I. General information

NPI: 1720133820
Provider Name (Legal Business Name): COUNTY OF GRAND
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 04/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 E CENTER ST
MOAB UT
84532-2429
US

IV. Provider business mailing address

125 E CENTER ST
MOAB UT
84532-2429
US

V. Phone/Fax

Practice location:
  • Phone: 435-259-1301
  • Fax: 435-259-1303
Mailing address:
  • Phone: 435-259-1301
  • Fax: 435-259-1303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number1001L
License Number StateUT

VII. Legacy identifiers

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

VIII. Authorized Official

Name: ANDY SMITH
Title or Position: DIRECTOR
Credential:
Phone: 435-259-1301