Provider Demographics
NPI:1124579230
Name:CARBON MEDICAL SERVICE ASSOCIATION, INCORPORTED
Entity Type:Organization
Organization Name:CARBON MEDICAL SERVICE ASSOCIATION, INCORPORTED
Other - Org Name:THE HELPER CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:ABEYTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-888-4411
Mailing Address - Street 1:PO BOX 930
Mailing Address - Street 2:
Mailing Address - City:EAST CARBON
Mailing Address - State:UT
Mailing Address - Zip Code:84520-0930
Mailing Address - Country:US
Mailing Address - Phone:435-888-4411
Mailing Address - Fax:435-888-2270
Practice Address - Street 1:331 HIGHWAY 123
Practice Address - Street 2:
Practice Address - City:SUNNYSIDE
Practice Address - State:UT
Practice Address - Zip Code:84539
Practice Address - Country:US
Practice Address - Phone:435-888-4411
Practice Address - Fax:435-888-2270
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CARBON MEDICAL SERVICE ASSOCIATION, INCORPORATED
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-10-24
Last Update Date:2019-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT=========Medicaid
UT=========031Medicaid
UT=========031Medicaid
UT461801Medicare PIN
UT=========027Medicaid