Healthcare Provider Details

I. General information

NPI: 1588978738
Provider Name (Legal Business Name): SAN JUAN COUNTY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2010
Last Update Date: 01/04/2024
Certification Date: 01/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5555 OLD AIRPORT ROAD
SPANISH VALLEY UT
84532
US

IV. Provider business mailing address

PO BOX 308
MONTICELLO UT
84535-0308
US

V. Phone/Fax

Practice location:
  • Phone: 435-587-1234
  • Fax:
Mailing address:
  • Phone: 435-587-2116
  • Fax: 435-587-2061

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CLAYTON HOLT
Title or Position: CEO
Credential:
Phone: 435-587-1116