Provider Demographics
NPI:1508494428
Name:UTAH NAVAJO HEALTH SYSTEM INCORPORATED
Entity Type:Organization
Organization Name:UTAH NAVAJO HEALTH SYSTEM INCORPORATED
Other - Org Name:NAVAJO MOUNTAIN HEALTH CENTER PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:JENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-651-3713
Mailing Address - Street 1:PO BOX 130
Mailing Address - Street 2:
Mailing Address - City:MONTEZUMA CREEK
Mailing Address - State:UT
Mailing Address - Zip Code:84534-0130
Mailing Address - Country:US
Mailing Address - Phone:435-651-3700
Mailing Address - Fax:435-678-0608
Practice Address - Street 1:#2 RAINBOW ROAD
Practice Address - Street 2:
Practice Address - City:NAVAJO MOUNTAIN
Practice Address - State:UT
Practice Address - Zip Code:86044
Practice Address - Country:US
Practice Address - Phone:928-672-2498
Practice Address - Fax:928-672-2839
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UTAH NAVAJO HEALTH SYSTEM INCORPORATED
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-03-27
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy