Provider Demographics
NPI:1356630354
Name:UTAH REFUGEE HEALTH CLINIC
Entity Type:Organization
Organization Name:UTAH REFUGEE HEALTH CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:REID
Authorized Official - Middle Name:JUSTIN
Authorized Official - Last Name:ROBISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-810-7311
Mailing Address - Street 1:676 EAST VINE STREET
Mailing Address - Street 2:SUITE 5
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-5514
Mailing Address - Country:US
Mailing Address - Phone:801-810-7311
Mailing Address - Fax:909-474-8883
Practice Address - Street 1:676 EAST VINE STREET
Practice Address - Street 2:SUITE 5
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84107-5514
Practice Address - Country:US
Practice Address - Phone:801-810-7311
Practice Address - Fax:909-474-8883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-31
Last Update Date:2011-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT370399-1205273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit