Organization
COMMUNITY HEALTH CENTERS, INC.
Active
Other names
72nd Street Medical Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER LYN THOMAS (EXECUTIVE DIRECTOR)
(801) 412-6920
Entity
Organization
Contact information
Practice address
220 W 7200 S, SUITE A, MIDVALE, UT 84047-1043
(801) 566-5494
(877) 497-4661
Mailing address
1455 W 2200 S STE 300, WEST VALLEY CITY, UT 84119-7219
(801) 412-6920
(877) 497-4661
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207V00000X
Obstetrics & Gynecology Physician
—
—
208000000X
Pediatrics Physician
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
261QM1300X
Multi-Specialty Clinic/Center
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1073611364
—
UT
Enumeration date
09/20/2006
Last updated
10/30/2023
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