Provider Demographics
NPI:1588978738
Name:SAN JUAN COUNTY HOSPITAL
Entity type:Organization
Organization Name:SAN JUAN COUNTY HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CLAYTON
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-587-1116
Mailing Address - Street 1:PO BOX 308
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:UT
Mailing Address - Zip Code:84535-0308
Mailing Address - Country:US
Mailing Address - Phone:435-587-2116
Mailing Address - Fax:435-587-2061
Practice Address - Street 1:5555 OLD AIRPORT ROAD
Practice Address - Street 2:
Practice Address - City:SPANISH VALLEY
Practice Address - State:UT
Practice Address - Zip Code:84532
Practice Address - Country:US
Practice Address - Phone:435-587-1234
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAN JUAN COUNTY HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-07-29
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty