Healthcare Provider Details

I. General information

NPI: 1649720723
Provider Name (Legal Business Name): CARBON MEDICAL SERVICE ASSOCIATION INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2016
Last Update Date: 08/12/2024
Certification Date: 08/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 S MAIN ST
HELPER UT
84526-1535
US

IV. Provider business mailing address

125 S MAIN ST
HELPER UT
84526-1535
US

V. Phone/Fax

Practice location:
  • Phone: 435-299-9165
  • Fax: 425-908-0768
Mailing address:
  • Phone: 435-472-3208
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number10190995-1703
License Number StateUT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier2166969
Identifier TypeOTHER
Identifier State
Identifier IssuerPK
# 2
Identifier1649720723
Identifier TypeMEDICAID
Identifier StateUT
Identifier Issuer

VIII. Authorized Official

Name: MICHAEL SMITH
Title or Position: PHARMACIST
Credential: PHARMD
Phone: 435-299-9165