Healthcare Provider Details

I. General information

NPI: 1932823481
Provider Name (Legal Business Name): MOUNTAINLANDS COMMUNITY HEALTH CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2022
Last Update Date: 03/27/2025
Certification Date: 03/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1680 W HIGHWAY 40 STE 201
VERNAL UT
84078-4142
US

IV. Provider business mailing address

589 S STATE ST
PROVO UT
84606-5056
US

V. Phone/Fax

Practice location:
  • Phone: 435-545-5175
  • Fax:
Mailing address:
  • Phone: 801-429-2000
  • Fax: 801-429-2002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: TODD BAILEY
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 801-429-2000