Healthcare Provider Details

I. General information

NPI: 1215001037
Provider Name (Legal Business Name): KANE COUNTY HUMAN RESOURCE SPECIAL SERVICE DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

355 N MAIN ST
KANAB UT
84741-3260
US

IV. Provider business mailing address

355 N MAIN ST
KANAB UT
84741-3260
US

V. Phone/Fax

Practice location:
  • Phone: 435-644-4100
  • Fax: 435-644-4197
Mailing address:
  • Phone: 435-644-4100
  • Fax: 435-644-4197

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. TOM MITCHELL
Title or Position: ADMINISTRATOR
Credential:
Phone: 435-644-5811