Provider Demographics
NPI:1073626412
Name:CENTRAL UTAH PUBLIC HEALTH DEPARTMENT
Entity Type:Organization
Organization Name:CENTRAL UTAH PUBLIC HEALTH DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEALTH OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:G
Authorized Official - Last Name:COSTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-896-5451
Mailing Address - Street 1:70 WESTVIEW DR
Mailing Address - Street 2:
Mailing Address - City:RICHFIELD
Mailing Address - State:UT
Mailing Address - Zip Code:84701-1868
Mailing Address - Country:US
Mailing Address - Phone:435-896-5451
Mailing Address - Fax:435-896-4353
Practice Address - Street 1:70 WESTVIEW DR
Practice Address - Street 2:
Practice Address - City:RICHFIELD
Practice Address - State:UT
Practice Address - Zip Code:84701-1868
Practice Address - Country:US
Practice Address - Phone:435-896-5451
Practice Address - Fax:435-896-4353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT004444039Medicare UPIN