Healthcare Provider Details

I. General information

NPI: 1689134868
Provider Name (Legal Business Name): GREEN RIVER MEDICAL CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2019
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

585 WEST MAIN STREET
GREEN RIVER UT
84525
US

IV. Provider business mailing address

PO BOX 417
GREEN RIVER UT
84525-0417
US

V. Phone/Fax

Practice location:
  • Phone: 435-564-3434
  • Fax: 435-564-3214
Mailing address:
  • Phone: 435-564-3434
  • Fax: 435-564-3214

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: PAULA JEAN DUNHAM
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 435-564-0213