Healthcare Provider Details

I. General information

NPI: 1619447653
Provider Name (Legal Business Name): CITY OF SANTA CLARA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2018
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2603 SANTA CLARA DR
SANTA CLARA UT
84765-5463
US

IV. Provider business mailing address

PO BOX 27768
SALT LAKE CITY UT
84127-0768
US

V. Phone/Fax

Practice location:
  • Phone: 435-673-6712
  • Fax: 435-628-7338
Mailing address:
  • Phone: 801-975-4385
  • Fax: 801-975-4323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number
License Number State

VIII. Authorized Official

Name: BROCK JACOBSEN
Title or Position: FINANCE DIRECTOR
Credential:
Phone: 435-673-6712