Healthcare Provider Details

I. General information

NPI: 1376696559
Provider Name (Legal Business Name): SANTAQUIN CITY CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 09/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 W 100 S
SANTAQUIN UT
84655-8009
US

IV. Provider business mailing address

45 W 100 S
SANTAQUIN UT
84655-8009
US

V. Phone/Fax

Practice location:
  • Phone: 801-754-1070
  • Fax:
Mailing address:
  • Phone: 801-754-1070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number2512L
License Number StateUT

VIII. Authorized Official

Name: PAUL TERRY
Title or Position: DIRECTOR OF EMS
Credential:
Phone: 801-754-1070