Provider Demographics
NPI:1427184068
Name:CITY OF WEST JORDAN
Entity type:Organization
Organization Name:CITY OF WEST JORDAN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:MR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:C
Authorized Official - Last Name:WARDLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-260-7300
Mailing Address - Street 1:7602 JORDAN LANDING BLVD
Mailing Address - Street 2:
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84084-1965
Mailing Address - Country:US
Mailing Address - Phone:801-260-7300
Mailing Address - Fax:
Practice Address - Street 1:7602 JORDAN LANDING BLVD
Practice Address - Street 2:
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84084-1965
Practice Address - Country:US
Practice Address - Phone:801-260-7300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT=========001Medicaid
UT=========001Medicaid
UT590008284Medicare PIN