Provider Demographics
NPI:1851357511
Name:UINTAH BASIN MEDICAL CENTER
Entity Type:Organization
Organization Name:UINTAH BASIN MEDICAL CENTER
Other - Org Name:DBA HOME CARE SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:MARSHALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-722-4691
Mailing Address - Street 1:250 W 300 N
Mailing Address - Street 2:
Mailing Address - City:ROOSEVELT
Mailing Address - State:UT
Mailing Address - Zip Code:84066-2336
Mailing Address - Country:US
Mailing Address - Phone:435-725-7448
Mailing Address - Fax:435-722-9291
Practice Address - Street 1:26 WEST 200 NORTH
Practice Address - Street 2:
Practice Address - City:ROOSEVELT
Practice Address - State:UT
Practice Address - Zip Code:84066-2329
Practice Address - Country:US
Practice Address - Phone:435-722-2418
Practice Address - Fax:435-722-6187
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UINTAH BASIN MEDICAL CENTER DBA HOME CARE SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-04-21
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2005-HOSP-180332B00000X, 332BP3500X, 332BX2000X
UT2011-HOSP-180332BX2000X
UT2005-HOSP-335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT=========071Medicaid
UT0512880001Medicare NSC
UT051288001Medicare ID - Type UnspecifiedPROVIDER NUMBER