Healthcare Provider Details

I. General information

NPI: 1639131907
Provider Name (Legal Business Name): CARBON MEDICAL SERVICE ASSOCIATION INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2006
Last Update Date: 08/14/2024
Certification Date: 08/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

331 E HIGHWAY 123
SUNNYSIDE UT
84539-7725
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 Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number StateUT

VIII. Authorized Official

Name: VANESSA ANDERSON
Title or Position: CREDENTIALING
Credential:
Phone: 435-888-4411