Healthcare Provider Details

I. General information

NPI: 1770173908
Provider Name (Legal Business Name): CARBON MEDICAL SERVICE ASSOCIATION INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2021
Last Update Date: 03/17/2025
Certification Date: 03/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

92 N 400 E STE 1
PRICE UT
84501-2509
US

IV. Provider business mailing address

PO BOX 460
SUNNYSIDE UT
84539-0460
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