Healthcare Provider Details

I. General information

NPI: 1437595030
Provider Name (Legal Business Name): MEDICO TRANSPORT SYSTEM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2013
Last Update Date: 05/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7365 S 4570 W
SOUTH JORDAN UT
84084
US

IV. Provider business mailing address

PO BOX 25
DRAPER UT
84020-0025
US

V. Phone/Fax

Practice location:
  • Phone: 928-242-1411
  • Fax: 888-762-9665
Mailing address:
  • Phone: 928-242-1411
  • Fax: 888-762-9665

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416A0800X
TaxonomyAir Ambulance
License Number
License Number State

VIII. Authorized Official

Name: MS. ROBYNN LEIGH LONGENBAUGH
Title or Position: A/R MANAGER
Credential: CPC
Phone: 928-242-1411