Provider Demographics
NPI:1619186558
Name:UTE MOUNTATIN UTE HEALTH CENTER
Entity Type:Organization
Organization Name:UTE MOUNTATIN UTE HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACTING CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:EARL
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:WARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-565-4441
Mailing Address - Street 1:PO BOX 49
Mailing Address - Street 2:232 RUSTING WILLOW STREET
Mailing Address - City:TOWAOC
Mailing Address - State:CO
Mailing Address - Zip Code:81334-0049
Mailing Address - Country:US
Mailing Address - Phone:970-565-4441
Mailing Address - Fax:970-565-9164
Practice Address - Street 1:232 RUSTLING WILLOW STREET
Practice Address - Street 2:COMPLES D
Practice Address - City:TOWAOC
Practice Address - State:CO
Practice Address - Zip Code:81334
Practice Address - Country:US
Practice Address - Phone:970-565-4441
Practice Address - Fax:970-565-9163
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO120269261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)