Provider Demographics
NPI:1891721577
Name:COUNTY OF WASATCH
Entity Type:Organization
Organization Name:COUNTY OF WASATCH
Other - Org Name:WASATCH COUNTY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HEALTH DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CAMERON
Authorized Official - Middle Name:D
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:MPS, LEHS
Authorized Official - Phone:435-657-3263
Mailing Address - Street 1:55 S 500 E
Mailing Address - Street 2:
Mailing Address - City:HEBER CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84032-1918
Mailing Address - Country:US
Mailing Address - Phone:435-654-2700
Mailing Address - Fax:435-654-2705
Practice Address - Street 1:55 S 500 E
Practice Address - Street 2:
Practice Address - City:HEBER CITY
Practice Address - State:UT
Practice Address - Zip Code:84032-1918
Practice Address - Country:US
Practice Address - Phone:435-654-2700
Practice Address - Fax:435-654-2705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT251B00000X, 251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT46106OtherPEHP
UT998877673007Medicaid
UTTPR09150OtherMOLINA
UT1891721577Medicare PIN
UT46106OtherPEHP