Healthcare Provider Details

I. General information

NPI: 1447296249
Provider Name (Legal Business Name): ASHLEY VALLEY MEDICAL CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2006
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
US

V. Phone/Fax

Practice location:
  • Phone: 435-789-3342
  • Fax: 435-789-1314
Mailing address:
  • Phone: 435-789-3342
  • Fax: 435-789-1314

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code282NR1301X
TaxonomyRural Acute Care Hospital
License Number2004HOSP165
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State

VIII. Authorized Official

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