Healthcare Provider Details

I. General information

NPI: 1700671641
Provider Name (Legal Business Name): CARBON MEDICAL SERVICE ASSOCIATION INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2025
Last Update Date: 04/11/2025
Certification Date: 04/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 S CARBON AVE
PRICE UT
84501-2801
US

IV. Provider business mailing address

PO BOX 930
EAST CARBON UT
84520-0930
US

V. Phone/Fax

Practice location:
  • Phone: 435-888-4411
  • Fax: 435-888-2270
Mailing address:
  • Phone: 435-888-4411
  • Fax: 435-888-2270

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: LISA KAY CLARK
Title or Position: CEO
Credential:
Phone: 435-888-4411