Healthcare Provider Details

I. General information

NPI: 1114121100
Provider Name (Legal Business Name): SAN JUAN COUNTY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2007
Last Update Date: 07/17/2024
Certification Date: 08/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

380 WEST 100 NORTH
MONTICELLO UT
84535-0308
US

IV. Provider business mailing address

PO BOX 308
MONTICELLO UT
84535-0308
US

V. Phone/Fax

Practice location:
  • Phone: 435-587-1123
  • Fax: 435-587-3016
Mailing address:
  • Phone: 435-587-2116
  • Fax: 435-587-2061

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0002X
TaxonomyEmergency Care Clinic/Center
License Number2006-HOSP-203
License Number StateUT

VIII. Authorized Official

Name: MR. FARLEY CROFTS
Title or Position: CFO
Credential:
Phone: 435-587-1116