Provider Demographics
NPI:1336316975
Name:PAIUTE INDIAN TRIBE OF UTAH
Entity Type:Organization
Organization Name:PAIUTE INDIAN TRIBE OF UTAH
Other - Org Name:RICHFIELD MEDICAL CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:TYLER
Authorized Official - Middle Name:
Authorized Official - Last Name:PRISBREY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-586-1112
Mailing Address - Street 1:440 N PAIUTE DR
Mailing Address - Street 2:
Mailing Address - City:CEDAR CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84720-2681
Mailing Address - Country:US
Mailing Address - Phone:435-586-1112
Mailing Address - Fax:435-867-1514
Practice Address - Street 1:826 N 100 E
Practice Address - Street 2:
Practice Address - City:RICHFIELD
Practice Address - State:UT
Practice Address - Zip Code:84701
Practice Address - Country:US
Practice Address - Phone:435-893-0977
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-13
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTTEZ060Medicare UPIN