NPIMap

Organization Active NPI

Carbon Medical Service Association Incorporated

  • Federally Qualified Health Center (FQHC)
  • Price, UT
National Provider Identifier
1770173908
Registry record updated Mar 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
CARBON MEDICAL SERVICE ASSOCIATION INCORPORATED
Practice address
92 N 400 E Ste 1
Price, UT 84501-2509
Phone
(435) 888-4411
Fax
(435) 888-2270
NPI assigned
Jan 21, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2025

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

Authorized official

Name
Lisa Kay Clark
Title
Ceo
Phone
(435) 888-4411

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

92 N 400 E Ste 1
Price, UT 84501-2509

Mailing address

PO Box 460
Sunnyside, UT 84539-0460
Phone (435) 888-4411

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20050606001229 UT Part B Supplier - Clinic/Group Practice 4183535115 Receives reassigned benefits from 21 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Helper, UT; Sunnyside, UT; Price, UT
O20210503002487 UT Part A Provider - Federally Qualified Health Center (FQHC) 4183535115 Practice locations: Price, UT

Federally qualified health center certification: CCN 461869

Legal name
CARBON MEDICAL SERVICE ASSOCIATION, INCORPORATED
Doing business as
THE PRICE CLINIC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Apr 12, 2021
Last certification
Apr 12, 2021
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Nov 5, 1952 in UT
Enrollment address
92 N 400 E
Ste 1
Price, UT 84501-2509

Other NPIs with the same Medicare PAC ID 2

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.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
46D2228267Price Clinic, the92 North 400 East, Suite #1, Price, UT 84501Certificate of waiverJun 23, 2027

National Provider Directory

National Provider Directory
Tax ID family
Carbon Medical Service Association Incorported5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

Locations

92 N 400 E
Ste 1
Price, UT 84501
Phone (435) 637-6338

Ownership & related parties

All disclosed owners & managing parties 13

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

NameRoleSinceShare
Crestina Trujillo Individual Corporate DirectorChief Financial Officer Jan 21, 2013
W-2 Managing Employee Jan 21, 2013
Jeff Braby Individual Corporate OfficerBoard Vice Chair Feb 27, 2019
Jack Ori Individual Corporate OfficerBoard Member Oct 30, 2013
Don Logston Individual Corporate OfficerBoard Member Apr 30, 2013
Cameron S Williams Individual Corporate Officer Jun 1, 2024
Alyssa Wilberg Individual Corporate OfficerBoard Secretary Jul 19, 2013
Michael Oshea Individual Corporate OfficerBoard Member Jan 27, 2021
Lisa Kay Clark Individual Corporate Director Jun 28, 2024
W-2 Managing Employee Jun 28, 2024
Kristy Candelaria Individual Corporate Officer Sep 27, 2023
Ramona Holt Individual Corporate OfficerBoard Treasurer Apr 23, 1997
Vanessa Anderson Individual Other Jun 28, 2024
Becky Colombo Individual Corporate Officer Sep 27, 2023
Kimalee Allred Individual Corporate OfficerBoard Member Jun 29, 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 21

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 21

NPI Registry JSON

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

{
    "created_epoch": "1611187200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1742169600000",
    "number": "1770173908",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 460",
            "city": "SUNNYSIDE",
            "state": "UT",
            "postal_code": "845390460",
            "telephone_number": "435-888-4411",
            "fax_number": "435-888-2270"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "92 N 400 E STE 1",
            "city": "PRICE",
            "state": "UT",
            "postal_code": "845012509",
            "telephone_number": "435-888-4411",
            "fax_number": "435-888-2270"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CARBON MEDICAL SERVICE ASSOCIATION INCORPORATED",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-01-21",
        "last_updated": "2025-03-17",
        "certification_date": "2025-03-17",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "LISA",
        "authorized_official_middle_name": "KAY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "435-888-4411"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Price, UT

Sources for this page

Verify at the official NPI Registry.