Provider Demographics
NPI:1588803415
Name:CENTERVILLE MEDICAL CENTER, INC.
Entity Type:Organization
Organization Name:CENTERVILLE MEDICAL CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:E
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:801-298-7330
Mailing Address - Street 1:174 W PARRISH LN
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84014-1821
Mailing Address - Country:US
Mailing Address - Phone:801-298-7330
Mailing Address - Fax:801-295-5434
Practice Address - Street 1:174 W PARRISH LN
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:UT
Practice Address - Zip Code:84014-1821
Practice Address - Country:US
Practice Address - Phone:801-298-7330
Practice Address - Fax:801-295-5434
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-17
Last Update Date:2009-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty