1942251459 NPI number — SAN JUAN COUNTY HOSPITAL

Table of content: (NPI 1942251459)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942251459 NPI number — SAN JUAN COUNTY HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SAN JUAN COUNTY HOSPITAL
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:
SAN JUAN HEALTH SERVICES DISTRICT
Provider Other Organization Name Type Code:
5
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:
1942251459
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/19/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 308
Provider Second Line Business Mailing Address:
380 W 100 N
Provider Business Mailing Address City Name:
MONTICELLO
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84535-0308
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
435-587-2116
Provider Business Mailing Address Fax Number:
435-587-2061

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
380 WEST 100 NORTH
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONTICELLO
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84535-0308
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
435-587-2116
Provider Business Practice Location Address Fax Number:
435-587-2061
Provider Enumeration Date:
05/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HOLT
Authorized Official First Name:
CLAYTON
Authorized Official Middle Name:
H.
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
435-587-2116

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X , with the licence number:  2015-ALI-203 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 275N00000X , with the licence number: 2006-HOSP-203 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 282NC0060X , with the licence number: 2006-HOSP-203 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com