Healthcare Provider Details

I. General information

NPI: 1902952062
Provider Name (Legal Business Name): SAN JUAN COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 07/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 SOUTH MAIN
MONTICELLO UT
84535
US

IV. Provider business mailing address

80 NORTH 300 WEST PO BOX 126
TROPIC UT
84776-0126
US

V. Phone/Fax

Practice location:
  • Phone: 435-587-3225
  • Fax:
Mailing address:
  • Phone: 435-679-8710
  • Fax: 435-679-8711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number1904L
License Number StateUT

VIII. Authorized Official

Name: MRS. LINDA LARSON
Title or Position: EMS COORDINATOR
Credential:
Phone: 435-587-3225