=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144250531
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PARK CITY FIRE SERVICE DISTRICT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/03/2006
-----------------------------------------------------
Last Update Date | 11/17/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 736 BITNER RD
-----------------------------------------------------
City | PARK CITY
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84098-5432
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 435-940-2500
-----------------------------------------------------
Fax | 435-940-2451
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 27768
-----------------------------------------------------
City | SALT LAKE CITY
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84127-0768
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-975-4319
-----------------------------------------------------
Fax | 801-352-9502
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BATTALION CHIEF
-----------------------------------------------------
Name | ASHLEY LEWIS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 435-940-2503
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------