Provider Demographics
NPI:1992917165
Name:LONE PEAK PUBLIC SAFETY DISTRICT
Entity type:Organization
Organization Name:LONE PEAK PUBLIC SAFETY DISTRICT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EMS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:G
Authorized Official - Last Name:FREEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:EMT
Authorized Official - Phone:801-763-5365
Mailing Address - Street 1:50 E 100 N
Mailing Address - Street 2:
Mailing Address - City:ALPINE
Mailing Address - State:UT
Mailing Address - Zip Code:84004
Mailing Address - Country:US
Mailing Address - Phone:801-763-5365
Mailing Address - Fax:
Practice Address - Street 1:50 E 100 N
Practice Address - Street 2:
Practice Address - City:ALPINE
Practice Address - State:UT
Practice Address - Zip Code:84004-1636
Practice Address - Country:US
Practice Address - Phone:801-763-5365
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2009-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2519-L341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT=========001Medicaid
UT000090565Medicare PIN
UT=========001Medicaid