Healthcare Provider Details

I. General information

NPI: 1194831552
Provider Name (Legal Business Name): MIDTOWN COMMUNITY HEALTH CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 04/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2240 ADAMS AVE
OGDEN UT
84401-1511
US

IV. Provider business mailing address

2240 ADAMS AVE
OGDEN UT
84401-1511
US

V. Phone/Fax

Practice location:
  • Phone: 801-395-8200
  • Fax: 801-436-1015
Mailing address:
  • Phone: 801-395-8200
  • Fax: 801-436-1015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number61891751704
License Number StateUT

VIII. Authorized Official

Name: ALICIA MARTINEZ
Title or Position: EXECUTIVE DIRECTOR
Credential: BSPHARM
Phone: 801-334-1321