Provider Demographics
NPI:1043380991
Name:KANE COUNTY HUMAN RESOURCE SPECIAL SERVICE DISTRICT
Entity Type:Organization
Organization Name:KANE COUNTY HUMAN RESOURCE SPECIAL SERVICE DISTRICT
Other - Org Name:KANE COUNTY HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SHERRIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:PANDYA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-644-5811
Mailing Address - Street 1:355 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:KANAB
Mailing Address - State:UT
Mailing Address - Zip Code:84741-3260
Mailing Address - Country:US
Mailing Address - Phone:435-644-5811
Mailing Address - Fax:435-644-3588
Practice Address - Street 1:355 N MAIN ST
Practice Address - Street 2:
Practice Address - City:KANAB
Practice Address - State:UT
Practice Address - Zip Code:84741-3260
Practice Address - Country:US
Practice Address - Phone:435-644-5811
Practice Address - Fax:435-644-3588
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2009-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2005-HOSP-425282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1852OtherPUBLIC EMPLOYEES HEALTH P
UT860096778048Medicaid
KY033359299OtherOWCP
UT876000300009Medicaid
UT87600030003OtherBLUE CROSS BLUE SHIELD
UT36832OtherDESERET MUTUAL BENEFIT AS
AZ020636OtherAHCCCS
UT103000790101OtherSELECT HEALTH
UT=========OtherTRICARE
UT103000790101OtherSELECT HEALTH
UT=========003Medicaid
UT=========003Medicaid
UT103000790101OtherSELECT HEALTH
UT=========KA1OtherEDUCATORS MUTUAL INS ASSO