Healthcare Provider Details

I. General information

NPI: 1073478855
Provider Name (Legal Business Name): URBAN INDIAN CENTER OF SALT LAKE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/23/2025
Last Update Date: 12/23/2025
Certification Date: 12/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5450 S GREEN ST STE A
SALT LAKE CITY UT
84123-5632
US

IV. Provider business mailing address

120 W 1300 S
SALT LAKE CITY UT
84115-5230
US

V. Phone/Fax

Practice location:
  • Phone: 801-486-4877
  • Fax:
Mailing address:
  • Phone: 801-486-4877
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM MATTHEW POSS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 858-204-2039