Organization
COMMUNITY HEALTH CENTERS, INC.
Active
Organization
COMMUNITY HEALTH CENTERS, INC.
Active
Other names
Ellis R. Shipp Medical Clinic, Ellis R. Ship Medical Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER THOMAS (EXECUTIVE DIRECTOR)
(801) 412-6920
Entity
Organization
Contact information
Practice address
4535 S 5600 W, WEST VALLEY CITY, UT 84120-4639
(801) 676-4405
(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
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1326417445
—
UT
Enumeration date
09/18/2015
Last updated
10/30/2023
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