Provider Demographics
NPI:1639131907
Name:CARBON MEDICAL SERVICE ASSOCIATION
Entity Type:Organization
Organization Name:CARBON MEDICAL SERVICE ASSOCIATION
Other - Org Name:CARBON MEDICAL SERVICE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:ABEYTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-888-4411
Mailing Address - Street 1:305 CENTER STREET
Mailing Address - Street 2:P. O. BOX 930
Mailing Address - City:EAST CARBON
Mailing Address - State:UT
Mailing Address - Zip Code:84520-0930
Mailing Address - Country:US
Mailing Address - Phone:435-888-4411
Mailing Address - Fax:435-888-2270
Practice Address - Street 1:331 E HIGHWAY 123
Practice Address - Street 2:
Practice Address - City:SUNNYSIDE
Practice Address - State:UT
Practice Address - Zip Code:84539-7725
Practice Address - Country:US
Practice Address - Phone:435-888-4411
Practice Address - Fax:435-888-2270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-04
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT=========Medicaid
UT4832080001Medicare NSC