Provider Demographics
NPI:1700857398
Name:MOAB VALLEY HEALTHCARE INC
Entity Type:Organization
Organization Name:MOAB VALLEY HEALTHCARE INC
Other - Org Name:MOAB REGIONAL HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:JO
Authorized Official - Last Name:SAFOFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-719-3514
Mailing Address - Street 1:PO BOX 998
Mailing Address - Street 2:450 WILLIAMS WAY
Mailing Address - City:MOAB
Mailing Address - State:UT
Mailing Address - Zip Code:84532
Mailing Address - Country:US
Mailing Address - Phone:435-719-3501
Mailing Address - Fax:435-719-3509
Practice Address - Street 1:450 WILLIAMS WAY
Practice Address - Street 2:
Practice Address - City:MOAB
Practice Address - State:UT
Practice Address - Zip Code:84532
Practice Address - Country:US
Practice Address - Phone:435-719-3538
Practice Address - Fax:435-719-3549
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MOAB VALLEY HEALTHCARE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-01-31
Last Update Date:2017-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody ImagingGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT870391981011Medicaid