| Confederated Tribes Of The Goshute Reservation | |
|
Hc 61 Box 6104 Ibapah UT 84034-6003 | |
| (435) 234-1138 | |
| Not Available |
| Full Name | Confederated Tribes Of The Goshute Reservation |
|---|---|
| Speciality | Clinic/center |
| Location | Hc 61 Box 6104, Ibapah, Utah |
| Authorized Official Name and Position | Virgil W Johnson (COUNCIL CHAIR) |
| Authorized Official Contact | 8018984814 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Confederated Tribes Of The Goshute Reservation Hc 61 Box 6104 Ibapah UT 84034-6003 Ph: (435) 234-1138 | Confederated Tribes Of The Goshute Reservation Hc 61 Box 6104 Ibapah UT 84034-6003 Ph: (435) 234-1138 |
| NPI Number | 1396199972 |
|---|---|
| Provider Enumeration Date | 04/20/2016 |
| Last Update Date | 04/20/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396199972 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Secondary |
| 261Q00000X | Clinic/center | 9453799-8906 (Utah) | Primary |
Confederated Tribes Of The Goshute Reservation Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 195 Tribal Center Rd, Ibapah, UT 84034 Phone: 435-234-1194 Fax: 435-234-1202 |