Provider Demographics
NPI:1093482770
Name:TRICOUNTY HEALTH DEPARTMENT
Entity Type:Organization
Organization Name:TRICOUNTY HEALTH DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING
Authorized Official - Prefix:
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:A
Authorized Official - Last Name:SLAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-247-1180
Mailing Address - Street 1:133 S 500 E
Mailing Address - Street 2:
Mailing Address - City:VERNAL
Mailing Address - State:UT
Mailing Address - Zip Code:84078-2728
Mailing Address - Country:US
Mailing Address - Phone:435-247-1177
Mailing Address - Fax:435-781-0536
Practice Address - Street 1:133 S 500 E
Practice Address - Street 2:
Practice Address - City:VERNAL
Practice Address - State:UT
Practice Address - Zip Code:84078-2728
Practice Address - Country:US
Practice Address - Phone:435-247-1177
Practice Address - Fax:435-781-0536
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-30
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1891728234Medicaid