Healthcare Provider Details

I. General information

NPI: 1508296310
Provider Name (Legal Business Name): CONFEDERATED TRIBES OF THE GOSHUTE INDIAN RESERVATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2013
Last Update Date: 12/19/2024
Certification Date: 12/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

195 TRIBAL CENTER RD
IBAPAH UT
84034
US

IV. Provider business mailing address

P.O. BOX 6104 195 TRIBAL CENTER RD
IBAPAH UT
84034-6104
US

V. Phone/Fax

Practice location:
  • Phone: 435-234-1138
  • Fax: 435-234-1202
Mailing address:
  • Phone: 435-234-1138
  • Fax: 435-234-1202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: MS. CHRISTINE STEELE
Title or Position: ACTING HEALTH DIRECTOR
Credential:
Phone: 435-234-1138