NPIMap

Organization Active NPI

Midtown Community Health Center Inc

Doing business as Midtown CHC Davis

  • Federally Qualified Health Center (FQHC)
  • Clearfield, UT
National Provider Identifier
1467644740
Registry record updated Dec 16, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
MIDTOWN COMMUNITY HEALTH CENTER INC
Doing business as
Midtown CHC Davis
Practice address
22 S State St Ste 1007
Clearfield, UT 84015-1043
Phone
(801) 334-0030
Fax
(833) 428-8412
NPI assigned
Aug 10, 2007
Last updated
Dec 16, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 16, 2025

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

Authorized official

Name
Alicia Dacy Martinez
Title
Chief Executive Officer
Phone
(801) 334-1321

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Community Health Clinic/Center 261QC1500X
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

22 S State St Ste 1007
Clearfield, UT 84015-1043

Mailing address

2240 Adams Ave
Ogden, UT 84401-1511
Phone (801) 393-5355

Other names 1

  • Midtown CHC Davis Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040218000005 UT Part B Supplier - Clinic/Group Practice 0345135414 Receives reassigned benefits from 44 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Clearfield, UT; Ogden, UT
O20071116000451 UT Part A Provider - Federally Qualified Health Center (FQHC) 0345135414 1 other NPI on this enrollment
Practice locations: Clearfield, UT

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1467644740. Details of each certification follow.

Federally qualified health center certification: CCN 461823

Legal name
MIDTOWN COMMUNITY HEALTH CENTER INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 11, 2008
Last certification
Jan 11, 2008
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jun 1, 1995 in UT
Enrollment address
22 S State St
Clearfield, UT 84015-1043
Related CCNs
461815

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 5

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

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 8

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Charles E Ulrich Individual Corporate Director Jul 21, 2021
Jesse Garcia Individual Corporate Director Sep 1, 2017
Alicia Martinez Individual Corporate Director Jan 25, 2016
W-2 Managing Employee Jan 25, 2016
John a Grima Individual Corporate Director Nov 1, 2007
Patricia Chadwick Individual Corporate Director Nov 1, 2007
Kent Meacham Individual Corporate Director Nov 1, 2007
Andrea Lockwood Individual Corporate Director Nov 1, 2007
Jesse Bush Individual Corporate Officer Jul 21, 2021
W-2 Managing EmployeeAd; Jul 21, 2021

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
Midtown Community Health Center IncWashington Terrace, UT, CCN 461824 Federally qualified health center Operational/Managerial Control Dec 14, 2009
Midtown Community Health Center IncOgden, UT, CCN 461815 Federally qualified health center Operational/Managerial Control Dec 14, 2009

Owned or controlled facilities with NPI records 2

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

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": "1186704000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1765843200000",
    "number": "1467644740",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2240 ADAMS AVE",
            "city": "OGDEN",
            "state": "UT",
            "postal_code": "844011511",
            "telephone_number": "801-393-5355",
            "fax_number": "801-394-4609"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22 S STATE ST STE 1007",
            "city": "CLEARFIELD",
            "state": "UT",
            "postal_code": "840151043",
            "telephone_number": "801-334-0030",
            "fax_number": "833-428-8412"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIDTOWN COMMUNITY HEALTH CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-10",
        "last_updated": "2025-12-16",
        "certification_date": "2025-12-16",
        "status": "A",
        "authorized_official_last_name": "MARTINEZ",
        "authorized_official_first_name": "ALICIA",
        "authorized_official_middle_name": "DACY",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "801-334-1321"
    },
    "taxonomies": [
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Midtown CHC Davis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Clearfield, UT

Sources for this page

Verify at the official NPI Registry.