Healthcare Provider Details

I. General information

NPI: 1821045840
Provider Name (Legal Business Name): SAN JUAN COUNTY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 07/17/2024
Certification Date: 07/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

735 S 200 W
BLANDING UT
84511-3922
US

IV. Provider business mailing address

735 S 200 W
BLANDING UT
84511-3909
US

V. Phone/Fax

Practice location:
  • Phone: 435-678-2254
  • Fax: 435-678-2534
Mailing address:
  • Phone: 435-678-2254
  • Fax: 435-678-2534

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2005HOSP-203
License Number StateUT

VIII. Authorized Official

Name: FARLEY CROFTS
Title or Position: CFO
Credential:
Phone: 435-587-1116