Healthcare Provider Details

I. General information

NPI: 1699803635
Provider Name (Legal Business Name): UTAH NAVAJO HEALTH SYSTEM, INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 06/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 WEST MEDICAL DRIVE
MONUMENT VALLEY UT
84536-0005
US

IV. Provider business mailing address

PO BOX 130
MONTEZUMA CREEK UT
84534-0130
US

V. Phone/Fax

Practice location:
  • Phone: 435-727-3000
  • Fax:
Mailing address:
  • Phone: 435-651-3766
  • Fax: 435-651-3642

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. MICHAEL JENSEN
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 435-651-3713