Provider Demographics
NPI:1699803635
Name:UTAH NAVAJO HEALTH SYSTEM, INCORPORATED
Entity type:Organization
Organization Name:UTAH NAVAJO HEALTH SYSTEM, INCORPORATED
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:JENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-651-3713
Mailing Address - Street 1:PO BOX 130
Mailing Address - Street 2:
Mailing Address - City:MONTEZUMA CREEK
Mailing Address - State:UT
Mailing Address - Zip Code:84534-0130
Mailing Address - Country:US
Mailing Address - Phone:435-651-3766
Mailing Address - Fax:435-651-3642
Practice Address - Street 1:30 WEST MEDICAL DRIVE
Practice Address - Street 2:
Practice Address - City:MONUMENT VALLEY
Practice Address - State:UT
Practice Address - Zip Code:84536-0005
Practice Address - Country:US
Practice Address - Phone:435-727-3000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1811991151OtherNPI MAIN LOCATION
UT461818Medicare Oscar/Certification
UT1811991151OtherNPI MAIN LOCATION