Provider Demographics
NPI:1992834006
Name:UTAH NAVAJO HEALTH SYSTEMS INC.
Entity Type:Organization
Organization Name:UTAH NAVAJO HEALTH SYSTEMS INC.
Other - Org Name:MONTEZUMA CREEK CHC PHARMACY
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO OF UNHS
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:JENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-678-3713
Mailing Address - Street 1:PO BOX 130
Mailing Address - Street 2:
Mailing Address - City:MONTEZUMA CREEK
Mailing Address - State:UT
Mailing Address - Zip Code:84534-0130
Mailing Address - Country:US
Mailing Address - Phone:435-651-3921
Mailing Address - Fax:435-651-3463
Practice Address - Street 1:1478 EAST HIGHWAY 162
Practice Address - Street 2:
Practice Address - City:MONTEZUMA CREEK
Practice Address - State:UT
Practice Address - Zip Code:84534-0130
Practice Address - Country:US
Practice Address - Phone:435-651-3700
Practice Address - Fax:435-678-0419
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2018-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT380808-1704333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT4608115OtherNAPB