Provider Demographics
NPI:1013961226
Name:MOAB MEDICAL CENTER INC.
Entity Type:Organization
Organization Name:MOAB MEDICAL CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:V
Authorized Official - Last Name:ROUZER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:435-259-0408
Mailing Address - Street 1:380 NORTH 500 WEST
Mailing Address - Street 2:
Mailing Address - City:MOAB
Mailing Address - State:UT
Mailing Address - Zip Code:84532-2232
Mailing Address - Country:US
Mailing Address - Phone:435-259-0408
Mailing Address - Fax:435-259-0448
Practice Address - Street 1:380 NORTH 500 WEST
Practice Address - Street 2:
Practice Address - City:MOAB
Practice Address - State:UT
Practice Address - Zip Code:84532-2232
Practice Address - Country:US
Practice Address - Phone:435-259-0408
Practice Address - Fax:435-259-0448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2009-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1767261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT=========OtherTAX ID#