MEDICARE: DAVIS COUNTY HEALTH QP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251K00000X	Public Health or Welfare Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003941535
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAVIS COUNTY HEALTH QP

Provider Business Mailing Address
First Line	:	PO BOX 618
Second Line	:
City	:	FARMINGTON
State	:	UT
Zip	:	84025-0618
Country	:	US
Telephone Number	:	801-451-3331
Fax Number	:	801-451-3331

Provider Business Practice Location Address
First Line	:	50 E STATE ST
Second Line	:
City	:	FARMINGTON
State	:	UT
Zip	:	84025-2343
Country	:	US
Telephone Number	:	801-451-3331
Fax Number	:	801-451-3331

Authorized Official
Title or Position	:	BILLING
Name	:	LEWIS GARRETT
Credential	:
Telephone Number	:	801-451-3343

Provider Enumeration Date	:	02/23/2007
Last Update Date	:	08/16/2007

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Directions to “DAVIS COUNTY HEALTH QP ” Practice Location

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