Organization
FORT DUCHESNE INDIAN HEALTH CENTER LABORATORY
Active
Parent organization
DHHS INDIAN HEALTH SERVICE
Organization subpart
Yes
Provider details
NPI number
Legal business name
DHHS INDIAN HEALTH SERVICE
Authorized official
GARY MARTIN PHARMACIST (CHIEF PHARMACIST)
(435) 725-6874
Entity
Organization
Contact information
Practice address
6822 EAST 1000 SOUTH, FORT DUCHESNE, UT 84026
(435) 725-6874
(435) 725-6889
Mailing address
6822 EAST 1000 SOUTH, FORT DUCHESNE, UT 84026
(435) 725-6874
(435) 725-6889
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
700000000009
—
UT
Enumeration date
07/21/2009
Last updated
04/04/2013
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