MEDICARE: MILFORD MEMORIAL HOSPITAL

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2024-NCF-F23-106569	OTHER	UT	LICENSURE

General Provider Information

NPI Number	:	1699533497
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MILFORD MEMORIAL HOSPITAL

Provider Business Mailing Address
First Line	:	PO BOX 640
Second Line	:
City	:	MILFORD
State	:	UT
Zip	:	84751-0640
Country	:	US
Telephone Number	:	435-387-2411
Fax Number	:

Provider Business Practice Location Address
First Line	:	1201 E 4500 S
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84117-4124
Country	:	US
Telephone Number	:	949-687-0233
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	TYLER MOSS
Credential	:
Telephone Number	:	435-438-7209

Provider Enumeration Date	:	03/07/2024
Last Update Date	:	05/23/2025

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