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NPI Code Detail

MEDICARE: COALVILLE HEALTH CENTER

MEDICARE: COALVILLE HEALTH CENTER
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QM1300XMulti-Specialty Clinic/Center1713511205UT

General Provider Information

NPI Number : 1164676698
Entity Type Code : Organization
Provider Name (Legal Business Name) : COALVILLE HEALTH CENTER
Provider Business Mailing Address
First Line : PO BOX 865
Second Line : 142S 50 E SUITE 102
City : COALVILLE
State : UT
Zip : 84017-0865
Country : US
Telephone Number : 435-336-4403
Fax Number : 435-336-5570
Provider Business Practice Location Address
First Line : 142 S 50 EAST SUITE 102
Second Line : POB 865
City : COALVILLE
State : UT
Zip : 84017-0865
Country : US
Telephone Number : 435-336-4403
Fax Number : 435-336-5570
Authorized Official
Title or Position : OWNER
Name : D. WAIN ALLEN
Credential : MD
Telephone Number : 435-783-4385
Provider Enumeration Date : 11/11/2008
Last Update Date : 11/11/2008

Similar Medicare Providers

1942224050 — DONALD WAIN ALLEN MD
Practice Location Address:
142 SOUTH 50 EAST , POB 865
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1720379936 — GREGORY IVERSON FAMILY MEDICINE PLLC
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1164448080 — RODNEY EDWARD WADE DPT
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Practice Location Address:
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Directions to “COALVILLE HEALTH CENTER ” Practice Location

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