MEDICARE: GOLD CROSS SERVICES, INC.

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	1803L	UT

General Provider Information

NPI Number	:	1679560502
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOLD CROSS SERVICES, INC.

Provider Business Mailing Address
First Line	:	1717 S REDWOOD RD
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84104-5110
Country	:	US
Telephone Number	:	801-975-4385
Fax Number	:	801-975-4359

Provider Business Practice Location Address
First Line	:	1717 S REDWOOD RD
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84104-5110
Country	:	US
Telephone Number	:	801-975-4385
Fax Number	:	801-975-4359

Authorized Official
Title or Position	:	COLLECTIONS MANAGER
Name	:	MRS. KRIS A PETERSON
Credential	:
Telephone Number	:	801-975-4339

Provider Enumeration Date	:	10/05/2005
Last Update Date	:	04/20/2008

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