NPIMap

Organization Active NPI

Utah Partners for Health

Doing business as Mid-Valley Health Clinic

  • Clinic/Center
  • Midvale, UT
National Provider Identifier
1508299892
Registry record updated Oct 2, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
UTAH PARTNERS FOR HEALTH
Doing business as
Mid-Valley Health Clinic
Practice address
8446 S Harrison St
Midvale, UT 84047-3501
Phone
(801) 417-0131
Fax
(801) 250-3204
NPI assigned
Aug 9, 2013
Last updated
Oct 2, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 2, 2013

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

Authorized official

Name
Mr. Kurt Micka
Title
Executive Director
Phone
(801) 417-0131

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X UT Primary

Addresses

Primary practice location

8446 S Harrison St
Midvale, UT 84047-3501

Mailing address

8446 S Harrison St
Midvale, UT 84047-3501
Phone (801) 417-0131

Other names 1

  • Mid-Valley Health Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT4 enrollments

Enrollment records 4

Enrollment IDStateProvider typePAC IDDetails
O20131002000251 UT Part B Supplier - Clinic/Group Practice 8224262480 Receives reassigned benefits from 18 practitioners
Practice locations: Midvale, UT; West Jordan, UT
O20140715002286 UT Part A Provider - Federally Qualified Health Center (FQHC) 8224262480 Practice locations: Midvale, UT
O20170712000765 UT Part A Provider - Federally Qualified Health Center (FQHC) 8224262480 Practice locations: Midvale, UT
O20200311001878 UT Part A Provider - Federally Qualified Health Center (FQHC) 8224262480 Practice locations: West Jordan, UT

NPI to CCN mapping 3

The Medicare certification numbers (CCNs) connected to NPI 1508299892. Details of each certification follow.

Federally qualified health center certification: CCN 461842

Legal name
UTAH PARTNERS FOR HEALTH
Doing business as
MID VALLEY HEALTH CLINIC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jul 10, 2014
Last certification
Jul 10, 2014
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jul 15, 2002 in UT
Enrollment address
8446 S Harrison Street
Midvale, UT 84047

Federally qualified health center certification: CCN 461858

Legal name
UTAH PARTNERS FOR HEALTH
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 4, 2016
Last certification
Oct 4, 2016
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jul 15, 2002 in UT
Enrollment address
7651 S Main St
Midvale, UT 84047-7101

Federally qualified health center certification: CCN 461865

Legal name
UTAH PARTNERS FOR HEALTH
Doing business as
UTAH PARTNERS FOR HEALTH FAMILY CLINIC - WEST JORDAN
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Feb 6, 2020
Last certification
Feb 6, 2020
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Sep 1, 2013 in UT
Enrollment address
9103 S 1300 W
Ste 102
West Jordan, UT 84088-6709

National Provider Directory

National Provider Directory

Locations

8446 S Harrison St
Midvale, UT 84047
Phone (801) 417-0131

Ownership & related parties

All disclosed owners & managing parties 18

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

NameRoleSinceShare
Cheryl Shepherd Individual Corporate OfficerTreasurer Nov 13, 2012
Corporate DirectorDirector May 6, 2008
Corporate Director May 2, 2014
Fahina Tavake-Pasi Individual Corporate DirectorDirector Jan 8, 2014
Corporate Director Aug 1, 2016
Serafina Ochoa Individual Corporate DirectorDirector Jul 16, 2013
Corporate Director May 2, 2014
Debra L Turner Individual 5% Or Greater Direct Ownership InterestCeo Oct 1, 2021
Corporate DirectorCeo Oct 1, 2021
Operational/Managerial ControlCeo Oct 1, 2021 100%
Corporate OfficerCeo Oct 1, 2021
W-2 Managing EmployeeCfo Dec 3, 2013
Cescilee Rall Individual Corporate DirectorDirector Jan 9, 2007
Corporate Director Aug 1, 2016
Lora L Coffman Individual W-2 Managing EmployeeBilling Credentialing Manager Nov 1, 2016 50%
W-2 Managing EmployeeBilling Manager Oct 24, 2016
W-2 Managing EmployeeBilling Manager Dec 24, 2016
Alfred Murillo Individual Corporate DirectorDirector Nov 13, 2012
Corporate Director May 2, 2014
Jessica M Latham Individual Corporate DirectorDirector Jan 8, 2013
Corporate Director May 2, 2014
Ana Rodriguez Individual Corporate DirectorDirector Feb 12, 2014
Jen McEntire Individual Corporate DirectorDirector Jan 8, 2014
Tami Eckstein Individual Corporate OfficerBoard Chair/President Jan 9, 2012
Corporate DirectorDirector Jan 1, 2014
Corporate Director May 2, 2014
Jamie Ferdinand Individual Corporate Director Aug 1, 2016
Nathan Peterson Individual Corporate Director Aug 1, 2016
Stormy Sharp Individual Corporate OfficerCfo May 25, 2022
Corporate OfficerCfo Jan 1, 2023 25%
Corporate Director Jan 1, 2023 25%
Burton Rojas Individual Corporate Director Aug 1, 2016
Cathie Erickson Individual Corporate Director Aug 1, 2016
Sean Petersen Individual Corporate Director Aug 1, 2016
Alma Monge Individual Corporate Director Aug 17, 2017

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 18

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 18

NPI Registry JSON

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

{
    "created_epoch": "1376006400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1380672000000",
    "number": "1508299892",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8446 S HARRISON ST",
            "city": "MIDVALE",
            "state": "UT",
            "postal_code": "840473501",
            "telephone_number": "801-417-0131",
            "fax_number": "801-250-3204"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8446 S HARRISON ST",
            "city": "MIDVALE",
            "state": "UT",
            "postal_code": "840473501",
            "telephone_number": "801-417-0131",
            "fax_number": "801-250-3204"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UTAH PARTNERS FOR HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-08-09",
        "last_updated": "2013-10-02",
        "status": "A",
        "authorized_official_last_name": "MICKA",
        "authorized_official_first_name": "KURT",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "801-417-0131",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "UT",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mid-Valley Health Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Midvale, UT

Sources for this page

Verify at the official NPI Registry.