Provider Demographics
NPI:1346566197
Name:UINTAH & OURAY INDIAN HEALTH SERVICES
Entity Type:Organization
Organization Name:UINTAH & OURAY INDIAN HEALTH SERVICES
Other - Org Name:INDIAN HEALTH SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:REGISTERED NURSE
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:HORROCKS
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED NURSE
Authorized Official - Phone:435-725-6850
Mailing Address - Street 1:1727 W 500 S
Mailing Address - Street 2:
Mailing Address - City:VERNAL
Mailing Address - State:UT
Mailing Address - Zip Code:84078-3913
Mailing Address - Country:US
Mailing Address - Phone:435-790-1892
Mailing Address - Fax:
Practice Address - Street 1:6822 E 1000 S
Practice Address - Street 2:
Practice Address - City:FT DUCHESNE
Practice Address - State:UT
Practice Address - Zip Code:84026
Practice Address - Country:US
Practice Address - Phone:435-725-6850
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-19
Last Update Date:2010-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT3441733102251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT700000000009Medicaid
UTHSZ216Medicare PIN