Provider Demographics
NPI:1164881686
Name:SOUTHERN UTE INDIAN TRIBE
Entity Type:Organization
Organization Name:SOUTHERN UTE INDIAN TRIBE
Other - Org Name:SOUTHERN UTE HEALTH CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:C
Authorized Official - Last Name:WINKLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-563-4742
Mailing Address - Street 1:PO BOX 737
Mailing Address - Street 2:
Mailing Address - City:IGNACIO
Mailing Address - State:CO
Mailing Address - Zip Code:81137-0737
Mailing Address - Country:US
Mailing Address - Phone:970-563-4742
Mailing Address - Fax:970-563-4833
Practice Address - Street 1:123 WEEMINUCHE
Practice Address - Street 2:
Practice Address - City:IGNACIO
Practice Address - State:CO
Practice Address - Zip Code:81137
Practice Address - Country:US
Practice Address - Phone:970-563-4742
Practice Address - Fax:970-563-4833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-11
Last Update Date:2016-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO18500323Medicaid
CO18500323Medicaid