Healthcare Provider Details

I. General information

NPI: 1235326679
Provider Name (Legal Business Name): SCIPIO TOWN CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2007
Last Update Date: 05/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 NORTH STATE STR
SCIPIO UT
84656-0063
US

IV. Provider business mailing address

160 NORTH STATE ST
SCIPIO UT
84656-0063
US

V. Phone/Fax

Practice location:
  • Phone: 435-758-2411
  • Fax:
Mailing address:
  • Phone: 435-758-2411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number1403L
License Number StateUT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: LARRY K ROBISON
Title or Position: TRAINING OFFICER
Credential:
Phone: 435-758-2411