MEDICARE: PLEASANT GROVE CITY CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3416L0300X	Land Ambulance	2504L	UT

General Provider Information

NPI Number	:	1235136235
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PLEASANT GROVE CITY CORPORATION

Provider Business Mailing Address
First Line	:	70 S 100 E
Second Line	:
City	:	PLEASANT GROVE
State	:	UT
Zip	:	84062-2702
Country	:	US
Telephone Number	:	801-785-5045
Fax Number	:	801-785-8925

Provider Business Practice Location Address
First Line	:	70 S 100 E
Second Line	:
City	:	PLEASANT GROVE
State	:	UT
Zip	:	84062-2702
Country	:	US
Telephone Number	:	801-785-5045
Fax Number	:	801-785-8925

Authorized Official
Title or Position	:	BILLING CLERK
Name	:	MRS. MOLLY JUNE PURDIE
Credential	:
Telephone Number	:	801-785-5045

Provider Enumeration Date	:	07/05/2005
Last Update Date	:	08/17/2010

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Directions to “PLEASANT GROVE CITY CORPORATION ” Practice Location

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