Healthcare Provider Details

I. General information

NPI: 1104672179
Provider Name (Legal Business Name): ASHLEY VALLEY MEDICAL CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

150 W 100 N
VERNAL UT
84078-2036
US

IV. Provider business mailing address

150 W 100 N
VERNAL UT
84078-2036
US

V. Phone/Fax

Practice location:
  • Phone: 435-789-3342
  • Fax:
Mailing address:
  • Phone: 435-789-3342
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State

VIII. Authorized Official

Name: CHARLOTTE LAWRENCE
Title or Position: SECRETARY
Credential:
Phone: 615-920-7000