Provider Demographics
NPI:1144259805
Name:COUNTY OF SUMMIT
Entity type:Organization
Organization Name:COUNTY OF SUMMIT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AUDITOR
Authorized Official - Prefix:
Authorized Official - First Name:BLAKE
Authorized Official - Middle Name:L
Authorized Official - Last Name:FRAZIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-336-3254
Mailing Address - Street 1:PO BOX 95970
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-0970
Mailing Address - Country:US
Mailing Address - Phone:801-352-9500
Mailing Address - Fax:801-352-9502
Practice Address - Street 1:210 EAST 400 SOUTH
Practice Address - Street 2:
Practice Address - City:KAMAS
Practice Address - State:UT
Practice Address - Zip Code:84036-0266
Practice Address - Country:US
Practice Address - Phone:435-783-6276
Practice Address - Fax:435-783-6277
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1144259805Medicaid
UT590011561OtherRAILROAD MEDICARE
UT1144259805Medicaid