Provider Demographics
NPI:1316977606
Name:PAYSON CITY AMBULANCE
Entity type:Organization
Organization Name:PAYSON CITY AMBULANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PAYSON CITY TREASURER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELAINE
Authorized Official - Middle Name:
Authorized Official - Last Name:OPENSHAW
Authorized Official - Suffix:
Authorized Official - Credentials:CPFA
Authorized Official - Phone:801-465-5206
Mailing Address - Street 1:439 W UTAH AVE
Mailing Address - Street 2:
Mailing Address - City:PAYSON
Mailing Address - State:UT
Mailing Address - Zip Code:84651-2042
Mailing Address - Country:US
Mailing Address - Phone:801-465-5206
Mailing Address - Fax:801-465-5208
Practice Address - Street 1:439 W UTAH AVE
Practice Address - Street 2:
Practice Address - City:PAYSON
Practice Address - State:UT
Practice Address - Zip Code:84651-2042
Practice Address - Country:US
Practice Address - Phone:801-465-5206
Practice Address - Fax:801-465-5208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2503L341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT876000263003Medicaid