Provider Demographics
NPI:1538559174
Name:SAN JUAN PUBLIC HEALTH
Entity type:Organization
Organization Name:SAN JUAN PUBLIC HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PUBLIC HEALTH DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WORTHY
Authorized Official - Middle Name:W
Authorized Official - Last Name:GLOVER
Authorized Official - Suffix:JR
Authorized Official - Credentials:MMHRM, CPM
Authorized Official - Phone:435-459-1151
Mailing Address - Street 1:PO BOX 9
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:UT
Mailing Address - Zip Code:84535-0009
Mailing Address - Country:US
Mailing Address - Phone:435-587-3225
Mailing Address - Fax:435-587-2425
Practice Address - Street 1:117 SOUTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:UT
Practice Address - Zip Code:84535-0009
Practice Address - Country:US
Practice Address - Phone:435-587-3225
Practice Address - Fax:435-587-2425
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAN JUAN COUNTY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-02-04
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare