Provider Demographics
NPI:1508822347
Name:UINTAH BASIN MEDICAL CENTER
Entity Type:Organization
Organization Name:UINTAH BASIN MEDICAL CENTER
Other - Org Name:UINTAH BASIN HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:MARSHALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-722-4691
Mailing Address - Street 1:26 W 200 N
Mailing Address - Street 2:
Mailing Address - City:ROOSEVELT
Mailing Address - State:UT
Mailing Address - Zip Code:84066-2329
Mailing Address - Country:US
Mailing Address - Phone:435-722-2418
Mailing Address - Fax:435-722-6187
Practice Address - Street 1:26 W 200 N
Practice Address - Street 2:
Practice Address - City:ROOSEVELT
Practice Address - State:UT
Practice Address - Zip Code:84066-2329
Practice Address - Country:US
Practice Address - Phone:435-722-2418
Practice Address - Fax:435-722-6187
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UINTAH BASIN MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-04-21
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2006-HHA-152251E00000X
UT2012-HHA-152251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT467039OtherPTAN