Healthcare Provider Details

I. General information

NPI: 1467396523
Provider Name (Legal Business Name): PAIUTE INDIAN TRIBE OF UTAH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2026
Last Update Date: 04/17/2026
Certification Date: 04/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

376 N PAIUTE DR
CEDAR CITY UT
84721-6181
US

IV. Provider business mailing address

440 N PAIUTE DR
CEDAR CITY UT
84721-6181
US

V. Phone/Fax

Practice location:
  • Phone: 435-867-1521
  • Fax:
Mailing address:
  • Phone: 435-586-1112
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: TYLER PRISBREY
Title or Position: CEO
Credential:
Phone: 435-586-1112