Provider Demographics
NPI:1801226907
Name:MOUNTAINLANDS COMMUNITY HEALTH CENTER INC
Entity Type:Organization
Organization Name:MOUNTAINLANDS COMMUNITY HEALTH CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:MBA, CMPE
Authorized Official - Phone:801-429-2000
Mailing Address - Street 1:589 S STATE ST STE 201
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84606-5056
Mailing Address - Country:US
Mailing Address - Phone:801-429-2000
Mailing Address - Fax:018-429-2001
Practice Address - Street 1:1680 W HIGHWAY 40
Practice Address - Street 2:SUITE 201
Practice Address - City:VERNAL
Practice Address - State:UT
Practice Address - Zip Code:84078-4135
Practice Address - Country:US
Practice Address - Phone:801-429-2000
Practice Address - Fax:801-429-2001
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MOUNTAINLANDS COMMUNITY HEALTH CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-11-26
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT461839Medicare Oscar/Certification