Provider Demographics
NPI:1285420414
Name:UINTAH BASIN MEDICAL CENTER
Entity type:Organization
Organization Name:UINTAH BASIN MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:
Authorized Official - Last Name:HALES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-722-6164
Mailing Address - Street 1:405 N 500 W
Mailing Address - Street 2:
Mailing Address - City:VERNAL
Mailing Address - State:UT
Mailing Address - Zip Code:84078-1907
Mailing Address - Country:US
Mailing Address - Phone:435-725-2054
Mailing Address - Fax:
Practice Address - Street 1:405 N 500 W
Practice Address - Street 2:
Practice Address - City:VERNAL
Practice Address - State:UT
Practice Address - Zip Code:84078-1907
Practice Address - Country:US
Practice Address - Phone:435-725-2054
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UINTAH BASIN MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-04-15
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy