MEDICARE: PAIUTE INDIAN TRIBE OF UTAH

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	261QF0400X	Federally Qualified Health Center (FQHC)

General Provider Information

NPI Number	:	1801063441
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PAIUTE INDIAN TRIBE OF UTAH

Provider Business Mailing Address
First Line	:	440 N PAIUTE DR
Second Line	:
City	:	CEDAR CITY
State	:	UT
Zip	:	84720-2681
Country	:	US
Telephone Number	:	435-586-1112
Fax Number	:	434-867-1514

Provider Business Practice Location Address
First Line	:	1449 N 1400 W STE 19
Second Line	:
City	:	ST GEORGE
State	:	UT
Zip	:	84770-5237
Country	:	US
Telephone Number	:	354-688-8199
Fax Number	:	435-688-7572

Authorized Official
Title or Position	:	CFO
Name	:	TYLER PRISBREY
Credential	:
Telephone Number	:	435-586-1112

Provider Enumeration Date	:	05/13/2008
Last Update Date	:	02/13/2024

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