NPIMap

Organization Active NPI

Fort Duchesne Indian Health Center Radiology

  • Radiology Clinic/Center
  • Fort Duchesne, UT
National Provider Identifier
1306076625
Registry record updated Apr 4, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Radiology Clinic/CenterTaxonomy code 261QR0200X
Legal business name
FORT DUCHESNE INDIAN HEALTH CENTER RADIOLOGY
Doing business as
Fort Duchesne Indian Health Center Radiology
Practice address
6822 East 1000 South
Fort Duchesne, UT 84026
Phone
(435) 725-6874
Fax
(435) 725-6889
NPI assigned
Jul 21, 2009
Last updated
Apr 4, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 4, 2013

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

Authorized official

Name
Mr. Delbert Gary Martin, RPHNPI 1073627212
Title
Chief Pharmacist
Phone
(435) 725-6874

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Radiology Clinic/Center 261QR0200X Primary

Addresses

Primary practice location

6822 East 1000 South
Fort Duchesne, UT 84026

Mailing address

6822 East 1000 South
Fort Duchesne, UT 84026
Phone (435) 725-6874

Other identifiers 1

IdentifierTypeStateIssuer
700000000009MedicaidUT

Other names 1

  • FORT DUCHESNE INDIAN HEALTH CENTER RADIOLOGY Doing business as

National Provider Directory

National Provider Directory
Tax ID family
DHHS IHS Phoenix Area6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1248134400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1365033600000",
    "number": "1306076625",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6822 EAST 1000 SOUTH",
            "city": "FORT DUCHESNE",
            "state": "UT",
            "postal_code": "84026",
            "telephone_number": "435-725-6874",
            "fax_number": "435-725-6889"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6822 EAST 1000 SOUTH",
            "city": "FORT DUCHESNE",
            "state": "UT",
            "postal_code": "84026",
            "telephone_number": "435-725-6874",
            "fax_number": "435-725-6889"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FORT DUCHESNE INDIAN HEALTH CENTER RADIOLOGY",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-07-21",
        "last_updated": "2013-04-04",
        "status": "A",
        "authorized_official_last_name": "MARTIN",
        "authorized_official_first_name": "DELBERT",
        "authorized_official_middle_name": "GARY",
        "authorized_official_title_or_position": "CHIEF PHARMACIST",
        "authorized_official_telephone_number": "435-725-6874",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "261QR0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "700000000009",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "FORT DUCHESNE INDIAN HEALTH CENTER RADIOLOGY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fort Duchesne, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.