MEDICARE: UTAH NAVAJO HEALTH SYSTEM, 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	333600000X	Pharmacy	58496301704	UT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4608115	OTHER	UT	NCPDP

General Provider Information

NPI Number	:	1699950873
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UTAH NAVAJO HEALTH SYSTEM, INC.

Provider Business Mailing Address
First Line	:	PO BOX 360005
Second Line	:	FOUR ROCK DOOR CANYON ROAD
City	:	MONUMENT VALLEY
State	:	UT
Zip	:	84536
Country	:	US
Telephone Number	:	435-727-3242
Fax Number	:	435-727-3272

Provider Business Practice Location Address
First Line	:	FOUR ROCK DOOR CANYON ROAD
Second Line	:
City	:	MONUMENT VALLEY
State	:	UT
Zip	:	84536
Country	:	US
Telephone Number	:	435-727-3242
Fax Number	:	435-727-3272

Authorized Official
Title or Position	:	CEO
Name	:	MRS. DONNA SINGER
Credential	:
Telephone Number	:	435-651-3291

Provider Enumeration Date	:	01/07/2008
Last Update Date	:	01/07/2008

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