Healthcare Provider Details

I. General information

NPI: 1972145811
Provider Name (Legal Business Name): UTAH NAVAJO HEALTH SYSTEM, INCORPOARTED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2019
Last Update Date: 01/27/2020
Certification Date: 01/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

802 S 200 W
BLANDING UT
84511-3910
US

IV. Provider business mailing address

PO BOX 130
MONTEZUMA CREEK UT
84534-0130
US

V. Phone/Fax

Practice location:
  • Phone: 435-651-3890
  • Fax:
Mailing address:
  • Phone: 435-651-3700
  • Fax: 435-678-0608

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL JENSEN
Title or Position: CEO
Credential:
Phone: 435-651-3713