Provider Demographics
NPI:1427064211
Name:MILFORD MEMORIAL HOSPITAL
Entity type:Organization
Organization Name:MILFORD MEMORIAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:TYLER
Authorized Official - Middle Name:
Authorized Official - Last Name:MOSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-438-7209
Mailing Address - Street 1:PO BOX 640
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:UT
Mailing Address - Zip Code:84751-0640
Mailing Address - Country:US
Mailing Address - Phone:435-387-2411
Mailing Address - Fax:435-387-5011
Practice Address - Street 1:850 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:UT
Practice Address - Zip Code:84751-7871
Practice Address - Country:US
Practice Address - Phone:435-387-2411
Practice Address - Fax:435-387-5011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2007-HOSP-192275N00000X
UT2005-HOSP-192282NC0060X
UT341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
No275N00000XHospital UnitsMedicare Defined Swing Bed Unit
No341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT=========005Medicaid
UT46Z305Medicare Oscar/Certification
UT461305Medicare Oscar/Certification