Healthcare Provider Details

I. General information

NPI: 1518409523
Provider Name (Legal Business Name): GUARDIAN FLIGHT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2016
Last Update Date: 11/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4800 AIRPORT RD
RIVERTON WY
82501-8207
US

IV. Provider business mailing address

10888 S 300 W
SOUTH JORDAN UT
84095-4043
US

V. Phone/Fax

Practice location:
  • Phone: 801-619-4900
  • Fax:
Mailing address:
  • Phone: 801-619-4900
  • Fax: 801-983-6052

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416A0800X
TaxonomyAir Ambulance
License Number148
License Number StateWY

VIII. Authorized Official

Name: JOSEPH L HUNT
Title or Position: PRESIDENT
Credential:
Phone: 801-619-4900