Healthcare Provider Details

I. General information

NPI: 1104972827
Provider Name (Legal Business Name): SALEM CITY CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 12/07/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 W 100 S
SALEM UT
84653
US

IV. Provider business mailing address

PO BOX 901
SALEM UT
84653-0901
US

V. Phone/Fax

Practice location:
  • Phone: 801-423-2770
  • Fax:
Mailing address:
  • Phone: 801-295-9880
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number2517L
License Number StateUT

VIII. Authorized Official

Name: JEFF NELSON
Title or Position: CHEIF
Credential:
Phone: 801-423-2770