1497717821 NPI number — CARBON MEDICAL SERVICE ASSOCIATION, INCORPORATED

Table of content: (NPI 1497717821)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497717821 NPI number — CARBON MEDICAL SERVICE ASSOCIATION, INCORPORATED

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARBON MEDICAL SERVICE ASSOCIATION, INCORPORATED
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:
1497717821
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/21/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
305 CENTER ST.
Provider Second Line Business Mailing Address:
P. O. BOX 930
Provider Business Mailing Address City Name:
EAST CARBON
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84520-0930
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
435-888-4411
Provider Business Mailing Address Fax Number:
435-888-2270

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
331 HIGHWAY 123
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SUNNYSIDE
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84539
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
435-888-4411
Provider Business Practice Location Address Fax Number:
435-888-2270
Provider Enumeration Date:
04/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ABEYTA
Authorized Official First Name:
CAROLYN
Authorized Official Middle Name:
SUE
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
435-888-4411

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QM1300X , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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