Healthcare Provider Details

I. General information

NPI: 1154334472
Provider Name (Legal Business Name): PLYMOUTH TOWN CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 04/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20120 N 5200 W
PLYMOUTH UT
84330
US

IV. Provider business mailing address

PO BOX 130
PLYMOUTH UT
84330-0130
US

V. Phone/Fax

Practice location:
  • Phone: 435-239-7278
  • Fax:
Mailing address:
  • Phone: 435-239-7278
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number0205L
License Number StateUT

VIII. Authorized Official

Name: JERIMY R ANDERSON
Title or Position: CHIEF
Credential:
Phone: 435-239-7278