Provider Demographics
NPI:1669584553
Name:BRIGHAM YOUNG UNIVERSITY HEALTH CENTER
Entity type:Organization
Organization Name:BRIGHAM YOUNG UNIVERSITY HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF FINANCIAL SERVICES
Authorized Official - Prefix:MR
Authorized Official - First Name:HUGH
Authorized Official - Middle Name:BRIAN
Authorized Official - Last Name:BLUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-293-3378
Mailing Address - Street 1:55-220 KULANUI ST
Mailing Address - Street 2:BYUH BOX #1916
Mailing Address - City:LAIE
Mailing Address - State:HI
Mailing Address - Zip Code:96762-1219
Mailing Address - Country:US
Mailing Address - Phone:808-293-3510
Mailing Address - Fax:808-293-3506
Practice Address - Street 1:55-220 KULANUI ST
Practice Address - Street 2:BYUH BOX #1916
Practice Address - City:LAIE
Practice Address - State:HI
Practice Address - Zip Code:96762-1219
Practice Address - Country:US
Practice Address - Phone:808-293-3510
Practice Address - Fax:808-293-3506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIP108674261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI013331-02Medicaid
HID43605Medicare UPIN
HI013331-02Medicaid