Healthcare Provider Details

I. General information

NPI: 1093818593
Provider Name (Legal Business Name): HILDALE HEALTH SERVICE CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1065 N HILDALE ST
HILDALE UT
84784-0459
US

IV. Provider business mailing address

1065 N HILDALE ST
HILDALE UT
84784-0459
US

V. Phone/Fax

Practice location:
  • Phone: 435-874-2217
  • Fax: 435-874-7817
Mailing address:
  • Phone: 435-874-2217
  • Fax: 435-874-7817

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. EZRA L. NIELSEN
Title or Position: ADMINISTRATOR
Credential:
Phone: 435-874-2217