Paiute Indian Tribe of Utah
Organization Active NPI Clinic/Center · Kanosh, UT
NPI 1992972525 · NPPES record last updated Feb 22, 2024
Key facts
- NPI
- 1992972525
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Clinic/Center 261Q00000X
- Legal business name
- PAIUTE INDIAN TRIBE OF UTAH
- Practice address
- 157 N Paiute Dr Reservation Rd
Kanosh, UT 84637 - Phone
- (435) 759-2610
- NPI assigned
- May 13, 2008
- Organization subpart
- No
Authorized official
- Name
- Mr. Tyler Prisbrey
- Title
- Cfo
- Phone
- (435) 586-1112
Other NPIs on the same Medicare enrollment 3
Other NPIs with the same Medicare PAC ID 3
Practitioners 22
-
Michael Brent Bulloch, D.O.
-
Tyler C Goddard, LCSW
-
Brent J. Lambeth, CMHC
-
Wes Nielsen, PA-C
-
Glendon Arly Pedersen, APRN
-
Justin Brett Robbins, APRN
-
Kirk Bjella, M.D.
-
Colby Bliss, PA-C
-
Kylee Kay Dalton, FNP-C
-
Shanda Laree Francisco, CADC II
-
Jody Jae Miller, APRN, FNP-C
-
David Morgan, PA-C
-
Michelle Morriss, LMFT
-
Richard Dwain Persons, PA-C MPAS
-
Maureen S Ramer, CSUDC
-
Brook David Rogers, PA-C
-
Spencer W Schmutz, PA-C
-
Julie A Wilcken, MPAS
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in TX, UT
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040127000849 | TX | Part B Supplier - Clinic/Group Practice | 3072414952 |
Receives reassigned benefits from 18 practitioners 3 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Cedar City, UT; Ivins, UT; Kanosh, UT; Richfield, UT; St George, UT |
| O20150803000383 | UT | Part a Provider - Indian Health Services Facility | 3072414952 | Practice locations: Kanosh, UT |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinic/Center | 261Q00000X | Yes |
Addresses
Primary practice location
157 N Paiute Dr Reservation Rd
Kanosh, UT 84637
Mailing address
440 N Paiute Dr
Cedar City, UT 84720-2681
Phone (435) 586-1112
Other names
- Kanosh Medical Clinic
Other providers in Kanosh, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 22, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.