Provider Demographics
NPI:1790173615
Name:HILDALE HEALTH SERVICES LLC
Entity Type:Organization
Organization Name:HILDALE HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:EZRA
Authorized Official - Middle Name:L
Authorized Official - Last Name:NIELSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-633-6750
Mailing Address - Street 1:PO BOX 840459
Mailing Address - Street 2:
Mailing Address - City:HILDALE
Mailing Address - State:UT
Mailing Address - Zip Code:84784-0459
Mailing Address - Country:US
Mailing Address - Phone:435-633-6750
Mailing Address - Fax:435-201-8680
Practice Address - Street 1:1065 N. HILDALE ST,
Practice Address - Street 2:
Practice Address - City:HILDALE
Practice Address - State:UT
Practice Address - Zip Code:84784-0459
Practice Address - Country:US
Practice Address - Phone:435-633-6750
Practice Address - Fax:435-201-8680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-30
Last Update Date:2014-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT186597-4405261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care