Provider Demographics
NPI:1700062296
Name:PAIUTE INDIAN TRIBE OF UTAH
Entity Type:Organization
Organization Name:PAIUTE INDIAN TRIBE OF UTAH
Other - Org Name:FOUR POINTS HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:TARA
Authorized Official - Middle Name:
Authorized Official - Last Name:PORATH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-867-1520
Mailing Address - Street 1:440 N PAIUTE DR
Mailing Address - Street 2:
Mailing Address - City:CEDAR CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84720-2681
Mailing Address - Country:US
Mailing Address - Phone:435-586-1112
Mailing Address - Fax:435-867-1514
Practice Address - Street 1:376 N PAIUTE DR
Practice Address - Street 2:
Practice Address - City:CEDAR CITY
Practice Address - State:UT
Practice Address - Zip Code:84721
Practice Address - Country:US
Practice Address - Phone:435-867-1520
Practice Address - Fax:435-238-4987
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-14
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTTEZ061Medicare UPIN