Provider Demographics
NPI:1790987840
Name:GARFIELD COUNTY
Entity Type:Organization
Organization Name:GARFIELD COUNTY
Other - Org Name:ORDERVILLE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ALBERTO
Authorized Official - Middle Name:
Authorized Official - Last Name:VASQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-676-8811
Mailing Address - Street 1:PO BOX 389
Mailing Address - Street 2:200 N 400 E
Mailing Address - City:PANGUITCH
Mailing Address - State:UT
Mailing Address - Zip Code:84759-0389
Mailing Address - Country:US
Mailing Address - Phone:435-676-8811
Mailing Address - Fax:435-676-2679
Practice Address - Street 1:425 E STATE ST
Practice Address - Street 2:
Practice Address - City:ORDERVILLE
Practice Address - State:UT
Practice Address - Zip Code:84758
Practice Address - Country:US
Practice Address - Phone:435-648-2108
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT463983Medicare ID - Type Unspecified