Healthcare Provider Details

I. General information

NPI: 1699760140
Provider Name (Legal Business Name): STRATA MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4313 BULLFROG NPS DRO HWY 276
LAKE POWELL UT
84533
US

IV. Provider business mailing address

80 W MAIN ST SUITE 201
PRICE UT
84501-2814
US

V. Phone/Fax

Practice location:
  • Phone: 435-684-2288
  • Fax: 435-684-2239
Mailing address:
  • Phone: 435-613-6500
  • Fax: 435-613-6515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1000X
TaxonomyStudent Health Clinic/Center
License Number1018291206
License Number StateUT

VIII. Authorized Official

Name: MR. CRAIG S HUMES
Title or Position: MANAGING PARTNER
Credential: PAC
Phone: 435-684-2288