Provider Demographics
NPI:1275050353
Name:SAN JUAN PUBLIC HEALTH SPECIAL SERVICE DISTRICT
Entity Type:Organization
Organization Name:SAN JUAN PUBLIC HEALTH SPECIAL SERVICE DISTRICT
Other - Org Name:SAN JUAN PUBLIC HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KIRK
Authorized Official - Middle Name:W
Authorized Official - Last Name:BENGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-678-2723
Mailing Address - Street 1:PO BOX E
Mailing Address - Street 2:
Mailing Address - City:BLANDING
Mailing Address - State:UT
Mailing Address - Zip Code:84511-0089
Mailing Address - Country:US
Mailing Address - Phone:435-678-2723
Mailing Address - Fax:435-678-3309
Practice Address - Street 1:735 SOUTH 200 WEST
Practice Address - Street 2:SUITE B
Practice Address - City:BLANDING
Practice Address - State:UT
Practice Address - Zip Code:84511
Practice Address - Country:US
Practice Address - Phone:435-678-2723
Practice Address - Fax:435-678-3309
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive MedicineGroup - Single Specialty