Healthcare Provider Details

I. General information

NPI: 1700857398
Provider Name (Legal Business Name): MOAB VALLEY HEALTHCARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2006
Last Update Date: 02/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 WILLIAMS WAY
MOAB UT
84532
US

IV. Provider business mailing address

PO BOX 998 450 WILLIAMS WAY
MOAB UT
84532
US

V. Phone/Fax

Practice location:
  • Phone: 435-719-3538
  • Fax: 435-719-3549
Mailing address:
  • Phone: 435-719-3501
  • Fax: 435-719-3509

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number
License Number StateNULL
# 6
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: MS. JENNIFER JO SAFOFF
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 435-719-3514