Healthcare Provider Details

I. General information

NPI: 1942251459
Provider Name (Legal Business Name): SAN JUAN COUNTY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 09/02/2025
Certification Date: 07/08/2022
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 308 380 W 100 N
MONTICELLO UT
84535-0308
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code275N00000X
TaxonomyMedicare Defined Swing Bed Hospital Unit
License Number2006-HOSP-203
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number2006-HOSP-203
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number2015-ALI-203
License Number StateUT

VIII. Authorized Official

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