1619186558 NPI number — UTE MOUNTATIN UTE HEALTH CENTER

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619186558 NPI number — UTE MOUNTATIN UTE HEALTH CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UTE MOUNTATIN UTE HEALTH CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1619186558
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/02/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 49
Provider Second Line Business Mailing Address:
232 RUSTING WILLOW STREET
Provider Business Mailing Address City Name:
TOWAOC
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
81334-0049
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
970-565-4441
Provider Business Mailing Address Fax Number:
970-565-9164

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
232 RUSTLING WILLOW STREET
Provider Second Line Business Practice Location Address:
COMPLES D
Provider Business Practice Location Address City Name:
TOWAOC
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
81334
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-565-4441
Provider Business Practice Location Address Fax Number:
970-565-9163
Provider Enumeration Date:
05/21/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WARD
Authorized Official First Name:
EARL
Authorized Official Middle Name:
DAVID
Authorized Official Title or Position:
ACTING CEO
Authorized Official Telephone Number:
970-565-4441

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X , with the licence number:  120269 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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