Provider Demographics
NPI:1659945343
Name:ENOCH COMMUNITY HEALTHCARE
Entity Type:Organization
Organization Name:ENOCH COMMUNITY HEALTHCARE
Other - Org Name:ENOCH HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER / COO
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:STARR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-263-0355
Mailing Address - Street 1:376 EAST MIDVALLEY ROAD
Mailing Address - Street 2:
Mailing Address - City:ENOCH
Mailing Address - State:UT
Mailing Address - Zip Code:84721
Mailing Address - Country:US
Mailing Address - Phone:435-263-0355
Mailing Address - Fax:435-263-0123
Practice Address - Street 1:476 E MIDVALLEY RD
Practice Address - Street 2:
Practice Address - City:ENOCH
Practice Address - State:UT
Practice Address - Zip Code:84721-7603
Practice Address - Country:US
Practice Address - Phone:435-263-0355
Practice Address - Fax:435-263-0123
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-17
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1225432669Medicaid