Organization
CONFEDERATED TRIBES OF THE GOSHUTE INDIAN RESERVATION
Active
Other names
Sacred Circle Healthcare
Organization subpart
No
Provider details
NPI number
Authorized official
CRYSTAL CONTRERAS (BILLING MANAGER)
(801) 359-2256
Entity
Organization
Contact information
Practice address
660 S 200 E STE 250, SLC, UT 84111-3846
(801) 359-2256
Mailing address
660 S 200 E STE 250, SLC, UT 84111-3846
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
461840
MEDICARE A
—
Enumeration date
09/13/2022
Last updated
09/13/2022
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