NPIMap

Organization Active NPI

Paiute Indian Tribe of Utah

  • Clinic/Center
  • Kanosh, UT
National Provider Identifier
1992972525
Registry record updated Feb 22, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 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
Last updated
Feb 22, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 22, 2024

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

Authorized official

Name
Mr. Tyler Prisbrey
Title
Cfo
Phone
(435) 586-1112

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X Primary

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 1

  • Kanosh Medical Clinic Other name

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
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

Other NPIs with the same Medicare PAC ID 3

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

Other NPIs on the same Medicare enrollment 3

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

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 22

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 22

NPI Registry JSON

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

{
    "created_epoch": "1210636800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1708560000000",
    "number": "1992972525",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "440 N PAIUTE DR",
            "city": "CEDAR CITY",
            "state": "UT",
            "postal_code": "847202681",
            "telephone_number": "435-586-1112",
            "fax_number": "435-867-1514"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "157 N PAIUTE DR RESERVATION RD",
            "city": "KANOSH",
            "state": "UT",
            "postal_code": "84637",
            "telephone_number": "435-759-2610"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PAIUTE INDIAN TRIBE OF UTAH",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-13",
        "last_updated": "2024-02-22",
        "certification_date": "2024-02-22",
        "status": "A",
        "authorized_official_last_name": "PRISBREY",
        "authorized_official_first_name": "TYLER",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "435-586-1112",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kanosh Medical Clinic",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Kanosh, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.