Healthcare Provider Details

I. General information

NPI: 1831351816
Provider Name (Legal Business Name): SAN JUAN COUNTY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2008
Last Update Date: 07/17/2024
Certification Date: 07/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

380 W 100 N
MONTICELLO UT
84535-0308
US

IV. Provider business mailing address

PO BOX 308
MONTICELLO UT
84535-0308
US

V. Phone/Fax

Practice location:
  • Phone: 435-587-2116
  • Fax: 435-587-3004
Mailing address:
  • Phone: 435-587-2116
  • Fax: 435-587-3004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code275N00000X
TaxonomyMedicare Defined Swing Bed Hospital Unit
License Number2006-HOSP-203
License Number StateUT

VIII. Authorized Official

Name: MR. CLAYTON H. HOLT
Title or Position: C.E.O.
Credential:
Phone: 435-587-2116