Provider Demographics
NPI:1598344426
Name:UTAH NAVAJO HEALTH SYSTEM INCORPORATED
Entity Type:Organization
Organization Name:UTAH NAVAJO HEALTH SYSTEM INCORPORATED
Other - Org Name:UTAH NAVAJO HEALTH SYSTEM INFUSION CENTER
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 1:910 S 300 W
Practice Address - Street 2:
Practice Address - City:BLANDING
Practice Address - State:UT
Practice Address - Zip Code:84511-3921
Practice Address - Country:US
Practice Address - Phone:435-678-3601
Practice Address - Fax:435-678-3610
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UTAH NAVAJO HEALTH SYSTEM INCORPORATED
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-04-07
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy