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General NPI Number Information
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NPI Number | 1073478855
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Entity Type | Organization
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Legal Business Name | URBAN INDIAN CENTER OF SALT LAKE
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Dates
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Enumeration Date | 12/23/2025
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Last Update Date | 12/23/2025
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Provider Practice Location Address
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Address Line | 5450 S GREEN ST STE A
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City | SALT LAKE CITY
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State | UT
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Zip | 84123-5632
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Country | US
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Telephone | 801-486-4877
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Fax |
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Provider Business Mailing Address
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Address Line | 120 W 1300 S
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City | SALT LAKE CITY
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State | UT
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Zip | 84115-5230
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Country | US
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Telephone | 801-486-4877
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | WILLIAM MATTHEW POSS
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Credential |
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Telephone | 858-204-2039
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0002X
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Taxonomy Name | Clinic Pharmacy
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License Number |
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License Number State |
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