Healthcare Provider Details

I. General information

NPI: 1124579230
Provider Name (Legal Business Name): CARBON MEDICAL SERVICE ASSOCIATION, INCORPORTED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2016
Last Update Date: 04/07/2025
Certification Date: 04/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

331 HIGHWAY 123
SUNNYSIDE UT
84539
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: MRS. LISA KAY CLARK
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 435-888-4411