| Northwestern Band Of The Shoshone Nation Health Clinic | |
|
984 S 500 W Ste 3 Brigham City UT 84302-4712 | |
| (435) 239-8524 | |
| Not Available |
| Full Name | Northwestern Band Of The Shoshone Nation Health Clinic |
|---|---|
| Speciality | General Practice |
| Location | 984 S 500 W Ste 3, Brigham City, Utah |
| Authorized Official Name and Position | Hunter Timbimboo (DIRECTOR OF HEALTH & HUMAN SERVICES) |
| Authorized Official Contact | 4352378066 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Northwestern Band Of The Shoshone Nation Health Clinic 707 N Main St Brigham City UT 84302-1449 Ph: (435) 734-2286 | Northwestern Band Of The Shoshone Nation Health Clinic 984 S 500 W Ste 3 Brigham City UT 84302-4712 Ph: (435) 239-8524 |
| NPI Number | 1841856986 |
|---|---|
| Provider Enumeration Date | 05/14/2019 |
| Last Update Date | 03/22/2021 |
| Medicare PECOS PAC ID | 4981011145 |
|---|---|
| Medicare Enrollment ID | O20210406000915 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1841856986 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Primary |
| Provider Name | Susan Beryl Harp |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1508912643 PECOS PAC ID: 8729160775 Enrollment ID: I20210406001308 |
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