NPIMap

Organization Active NPI

Uintah Basin Medical Center Inc

Doing business as Uintah Basin Medical Center Outpatient Pharmacy

  • Pharmacy
  • Roosevelt, UT
National Provider Identifier
1417022864
Registry record updated Apr 16, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacyTaxonomy code 333600000X
Legal business name
UINTAH BASIN MEDICAL CENTER INC
Doing business as
Uintah Basin Medical Center Outpatient Pharmacy
Practice address
250 W 300 N
(75-2)
Roosevelt, UT 84066-2336
Phone
(435) 722-6123
NPI assigned
Nov 21, 2006
Last updated
Apr 16, 2021By the provider in NPPES
Organization subpart
Yes
Parent organization
UINTAH BASIN MEDICAL CENTER INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 16, 2021

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

Authorized official

Name
James Marshall
Title
Ceo
Phone
(435) 722-6162

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X NU Primary
Clinic Pharmacy 3336C0002X 4788706-1703 UT
Long Term Care Pharmacy 3336L0003X 4788706-1703 UT
Compounding Pharmacy 3336C0004X 4788706-1703 UT

Addresses

Primary practice location

250 W 300 N
(75-2)
Roosevelt, UT 84066-2336

Mailing address

250 W 300 N
(75-2)
Roosevelt, UT 84066-2336
Phone (435) 722-6123

Other names 1

  • Uintah Basin Medical Center Outpatient Pharmacy Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210621003130 UT Part B Supplier - Mass Immunization (Roster Biller Only) 0244131944 2 other NPIs on this enrollment
Practice locations: Duchesne, UT; Vernal, UT; Roosevelt, UT

Other NPIs with the same Medicare PAC ID 8

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

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Duchesne Co Hosp12 organizations share this tax ID, including this one
Part of
Duchesne Co Hosp

Other organizations with this tax ID 11

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

Locations

250 W 300 N
#752
Roosevelt, UT 84066
Phone (435) 722-4691

Ownership & related parties

All facility ownership & control disclosures 4

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

FacilityTypeRoleSince
Uintah Basin Rehabilitation and Senior VillaRoosevelt, UT, CCN 465084 Skilled nursing facility Operational/Managerial Control (100%)
Adp of the SNF		 May 31, 2016
May 31, 2016
Uintah Basin Medical Center the Clinic RooseveltRoosevelt, UT, CCN 463994 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Apr 14, 2020
Uintah Basin Medical Center the Clinic DuchesneDuchesne, UT, CCN 463995 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Apr 14, 2020
Uintah Basin Medical Center the Clinic VernalVernal, UT, CCN 463997 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Oct 12, 2014

Owned or controlled facilities with NPI records 4

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

NPI Registry JSON

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

{
    "created_epoch": "1164067200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1618531200000",
    "number": "1417022864",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "250 W 300 N",
            "address_2": "(75-2)",
            "city": "ROOSEVELT",
            "state": "UT",
            "postal_code": "840662336",
            "telephone_number": "435-722-6123"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "250 W 300 N",
            "address_2": "(75-2)",
            "city": "ROOSEVELT",
            "state": "UT",
            "postal_code": "840662336",
            "telephone_number": "435-722-6123"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UINTAH BASIN MEDICAL CENTER INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "UINTAH BASIN MEDICAL CENTER INC",
        "enumeration_date": "2006-11-21",
        "last_updated": "2021-04-16",
        "certification_date": "2021-04-16",
        "status": "A",
        "authorized_official_last_name": "MARSHALL",
        "authorized_official_first_name": "JAMES",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "435-722-6162"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "3336C0002X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Clinic Pharmacy",
            "state": "UT",
            "license": "4788706-1703",
            "primary": false
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "UT",
            "license": "4788706-1703",
            "primary": false
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": "UT",
            "license": "4788706-1703",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Uintah Basin Medical Center Outpatient Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Roosevelt, UT

Sources for this page

Verify at the official NPI Registry.