NPIMap

Organization Active NPI

Moab Valley Healthcare, Inc.

Doing business as Portal Pharmacy

  • Community/Retail Pharmacy
  • Moab, UT
National Provider Identifier
1235918962
Registry record updated Dec 3, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
MOAB VALLEY HEALTHCARE, INC.
Doing business as
Portal Pharmacy
Practice address
480 W Williams Way
Moab, UT 84532
Phone
(435) 719-5555
Fax
(435) 719-5556
NPI assigned
Sep 22, 2023
Last updated
Dec 3, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
MOAB VALLEY HEALTHCARE, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 3, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Zach Wojcieszek
Title
Cfo
Phone
(435) 719-3558

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X NU Primary

Addresses

Primary practice location

480 W Williams Way
Moab, UT 84532

Mailing address

480 W Williams Way
Moab, UT 84532

Other names 1

  • PORTAL PHARMACY Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240919000637 UT Part B Supplier - Pharmacy 2466361720 Practice locations: Moab, UT

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Amh Pro Fee Billing3 organizations share this tax ID, including this one
Part of
Amh Pro Fee Billing

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

799 S 200 W
Blanding, UT 84511
Phone (435) 678-3601

380 N 500 W
#2
Moab, UT 84532
Phone (435) 259-7425

380 N 500 W
Ste 2
Moab, UT 84532
Phone (435) 259-7425

476 W Williams Way
#B
Moab, UT 84532
Phone (435) 719-3500

480 W Williams Way
Moab, UT 84532
Phone (435) 719-5555

630 W 400 N
Moab, UT 84532
Phone (435) 259-0022

Ownership & related parties

All facility ownership & control disclosures 3

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Moab Regional HospitalMoab, UT, CCN 461302 Hospital Operational/Managerial Control May 22, 1995
Moab Regional HospitalMoab, UT, CCN 46Z302 Hospital Operational/Managerial Control (100%) May 22, 1995
Grand County HospiceMoab, UT, CCN 461518 Hospice Operational/Managerial Control Nov 11, 2008

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 65

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 65

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1695340800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1733184000000",
    "number": "1235918962",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "480 W WILLIAMS WAY",
            "city": "MOAB",
            "state": "UT",
            "postal_code": "84532"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "480 W WILLIAMS WAY",
            "city": "MOAB",
            "state": "UT",
            "postal_code": "84532",
            "telephone_number": "435-719-5555",
            "fax_number": "435-719-5556"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOAB VALLEY HEALTHCARE, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MOAB VALLEY HEALTHCARE, INC.",
        "enumeration_date": "2023-09-22",
        "last_updated": "2024-12-03",
        "certification_date": "2024-12-03",
        "status": "A",
        "authorized_official_last_name": "WOJCIESZEK",
        "authorized_official_first_name": "ZACH",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "435-719-3558"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PORTAL PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "PORTAL PHARMACY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Moab, UT

Sources for this page

Verify at the official NPI Registry.