MEDICARE: UINTAH HEALTH CARE SPECIAL SERVICE DISTRICT

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	314000000X	Skilled Nursing Facility	2005-NCF-94	UT

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	:	1215935432
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UINTAH HEALTH CARE SPECIAL SERVICE DISTRICT

Provider Business Mailing Address
First Line	:	510 S 500 W
Second Line	:
City	:	VERNAL
State	:	UT
Zip	:	84078-4301
Country	:	US
Telephone Number	:	435-781-3505
Fax Number	:	435-789-3201

Provider Business Practice Location Address
First Line	:	510 S 500 W
Second Line	:
City	:	VERNAL
State	:	UT
Zip	:	84078-4301
Country	:	US
Telephone Number	:	435-781-3500
Fax Number	:	435-789-3201

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	WAYNE DUNBAR
Credential	:
Telephone Number	:	435-781-3511

Provider Enumeration Date	:	07/12/2005
Last Update Date	:	07/06/2017

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