Healthcare Provider Details

I. General information

NPI: 1447140389
Provider Name (Legal Business Name): BLACKWELL INFINITY HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2025
Last Update Date: 07/03/2025
Certification Date: 07/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

754 S 150 E
SMITHFIELD UT
84335-4710
US

IV. Provider business mailing address

754 S 150 E
SMITHFIELD UT
84335-4710
US

V. Phone/Fax

Practice location:
  • Phone: 435-512-0978
  • Fax:
Mailing address:
  • Phone: 435-512-0978
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: COREY BINGHAM
Title or Position: CEO
Credential: FNP-BC
Phone: 435-512-0978