=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629148085
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FARMINGTON CITY CORP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/09/2006
-----------------------------------------------------
Last Update Date | 09/09/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 130 N MAIN ST
-----------------------------------------------------
City | FARMINGTON
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84025-3518
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-451-2842
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 160
-----------------------------------------------------
City | FARMINGTON
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84025-0160
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-295-9880
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | FIRE CHIEF
-----------------------------------------------------
Name | GUIDO SMITH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 801-451-2842
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number | 0630L
-----------------------------------------------------
License Number State | UT
-----------------------------------------------------