Provider Demographics
NPI:1225109036
Name:UTAH COUNTY
Entity Type:Organization
Organization Name:UTAH COUNTY
Other - Org Name:UTAH COUNTY BYB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:K
Authorized Official - Last Name:MINER
Authorized Official - Suffix:
Authorized Official - Credentials:MD MSPH
Authorized Official - Phone:801-851-7011
Mailing Address - Street 1:151 S UNIVERSITY AVE
Mailing Address - Street 2:SUITE 1900
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84601-4427
Mailing Address - Country:US
Mailing Address - Phone:801-851-7042
Mailing Address - Fax:801-343-8724
Practice Address - Street 1:151 S UNIVERSITY AVE
Practice Address - Street 2:SUITE 1900
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84601-4427
Practice Address - Country:US
Practice Address - Phone:801-851-7042
Practice Address - Fax:801-851-7063
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UTAH COUNTY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-13
Last Update Date:2010-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT251K00000X251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT55102OtherPEHP PROVIDER ID
UTPR00489Medicaid
UT998877660009Medicaid
UT73-00012OtherUNITED HEALTH CARE ID
UTQM0000039389OtherALTIUS PROVIDER ID
UT103003506102OtherSELECT HEALTH ID
UT998877660009Medicaid