Healthcare Provider Details

I. General information

NPI: 1194655209
Provider Name (Legal Business Name): SALT CREEK HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2026
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

84 S STATE ST
FOUNTAIN GREEN UT
84632-7640
US

IV. Provider business mailing address

84 S STATE ST
FOUNTAIN GREEN UT
84632-7640
US

V. Phone/Fax

Practice location:
  • Phone: 801-427-2226
  • Fax:
Mailing address:
  • Phone: 801-427-2226
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JODI LYN PUTNAM
Title or Position: CO-OWNER
Credential: NP
Phone: 802-427-2226