Provider Demographics
NPI:1629159637
Name:COUNTY OF SUMMIT
Entity Type:Organization
Organization Name:COUNTY OF SUMMIT
Other - Org Name:SUMMIT COUNTY PUBLIC HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:NURSING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:
Authorized Official - Last Name:MOSS
Authorized Official - Suffix:
Authorized Official - Credentials:BSM, RN
Authorized Official - Phone:435-333-1504
Mailing Address - Street 1:85 N 50 E
Mailing Address - Street 2:PO BOX 128
Mailing Address - City:COALVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84017
Mailing Address - Country:US
Mailing Address - Phone:435-333-1504
Mailing Address - Fax:
Practice Address - Street 1:650 ROUND VALLEY DR
Practice Address - Street 2:
Practice Address - City:PARK CITY
Practice Address - State:UT
Practice Address - Zip Code:84060
Practice Address - Country:US
Practice Address - Phone:435-333-1504
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT=========011Medicaid
UT=========055Medicaid
UT=========011Medicaid