Provider Demographics
NPI:1336277904
Name:UTAH NAVAJO HEALTH SYSTEM, INCORPOARTED
Entity Type:Organization
Organization Name:UTAH NAVAJO HEALTH SYSTEM, INCORPOARTED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
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:435-651-3713
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:435-651-3291
Mailing Address - Fax:435-651-3642
Practice Address - Street 1:#2 RAINBOW ROAD
Practice Address - Street 2:
Practice Address - City:NAVAJO MOUNTAIN
Practice Address - State:UT
Practice Address - Zip Code:86044
Practice Address - Country:US
Practice Address - Phone:928-672-2839
Practice Address - Fax:928-672-2839
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT296101-99221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1811991151Medicaid