Provider Demographics
NPI:1629034376
Name:UINTAH BASIN MEDICAL CENTER
Entity Type:Organization
Organization Name:UINTAH BASIN MEDICAL CENTER
Other - Org Name:
Other - Org Type:
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
UT2005-HOSPICE-821251G00000X
UT2011-HOSPICE-821251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT461510OtherPTAN