Healthcare Provider Details

I. General information

NPI: 1013186717
Provider Name (Legal Business Name): MIDTOWN COMMUNITY HEALTH CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2008
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5285 S 400 E STE A
WASHINGTON TERRACE UT
84405-7194
US

IV. Provider business mailing address

2240 ADAMS AVE
OGDEN UT
84401-1511
US

V. Phone/Fax

Practice location:
  • Phone: 801-334-0048
  • Fax: 833-428-8406
Mailing address:
  • Phone: 801-393-5355
  • Fax: 801-394-4609

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: ALICIA DACY MARTINEZ
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 801-334-1321