Provider Demographics
NPI:1245385814
Name:EMERY EMERGENCY MEDICAL SPECIAL SERVICE DISTRICT
Entity type:Organization
Organization Name:EMERY EMERGENCY MEDICAL SPECIAL SERVICE DISTRICT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EMS COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:STONEY
Authorized Official - Middle Name:
Authorized Official - Last Name:JENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-820-0574
Mailing Address - Street 1:PO BOX 126
Mailing Address - Street 2:60 NORTH 300 WEST
Mailing Address - City:TROPIC
Mailing Address - State:UT
Mailing Address - Zip Code:84776
Mailing Address - Country:US
Mailing Address - Phone:435-679-8710
Mailing Address - Fax:435-679-8711
Practice Address - Street 1:360 NORTH MAIN
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:UT
Practice Address - Zip Code:84528
Practice Address - Country:US
Practice Address - Phone:435-820-0574
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2025-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT0801L3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT876000294000Medicaid
UT1245230192Medicaid