Provider Demographics
NPI:1265250823
Name:MAIN AND CENTER HEALTH LLC
Entity type:Organization
Organization Name:MAIN AND CENTER HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:BETTY
Authorized Official - Middle Name:
Authorized Official - Last Name:GOULD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-931-0063
Mailing Address - Street 1:HC 65 BOX 164
Mailing Address - Street 2:
Mailing Address - City:KANARRAVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84742-6502
Mailing Address - Country:US
Mailing Address - Phone:801-931-0063
Mailing Address - Fax:
Practice Address - Street 1:20 N MAIN
Practice Address - Street 2:
Practice Address - City:KANARRAVILLE
Practice Address - State:UT
Practice Address - Zip Code:84742
Practice Address - Country:US
Practice Address - Phone:801-931-0063
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-01
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty