MEDICARE: MIDTOWN COMMUNITY HEALTH CENTER INC

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	261QC1500X	Community Health Clinic/Center
2	261QF0400X	Federally Qualified Health Center (FQHC)

General Provider Information

NPI Number	:	1033547567
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIDTOWN COMMUNITY HEALTH CENTER INC

Provider Business Mailing Address
First Line	:	2240 ADAMS AVE
Second Line	:
City	:	OGDEN
State	:	UT
Zip	:	84401-1511
Country	:	US
Telephone Number	:	801-393-5355
Fax Number	:	801-394-4609

Provider Business Practice Location Address
First Line	:	60 E 3750 S
Second Line	:
City	:	SOUTH SALT LAKE
State	:	UT
Zip	:	84115-4428
Country	:	US
Telephone Number	:	801-486-0911
Fax Number	:	833-428-8495

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	ALICIA DACY MARTINEZ
Credential	:
Telephone Number	:	801-334-1321

Provider Enumeration Date	:	10/18/2013
Last Update Date	:	12/16/2025

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