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General NPI Number Information
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NPI Number | 1699760140
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Entity Type | Organization
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Legal Business Name | STRATA MEDICAL LLC
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Dates
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Enumeration Date | 09/12/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4313 BULLFROG NPS DRO HWY 276
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City | LAKE POWELL
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State | UT
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Zip | 84533
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Country | US
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Telephone | 435-684-2288
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Fax | 435-684-2239
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Provider Business Mailing Address
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Address Line | 80 W MAIN ST SUITE 201
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City | PRICE
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State | UT
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Zip | 84501-2814
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Country | US
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Telephone | 435-613-6500
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Fax | 435-613-6515
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | MR. CRAIG S HUMES
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Credential | PAC
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Telephone | 435-684-2288
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QS1000X
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Taxonomy Name | Student Health Clinic/Center
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License Number | 1018291206
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License Number State | UT
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