Organization
MOUNTAINLANDS COMMUNITY HEALTH CENTER, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KARRY LONTINE (CREDENTIALING)
(801) 855-0093
Entity
Organization
Contact information
Practice address
589 S STATE ST, PROVO, UT 84606-5056
(801) 429-2000
(801) 429-2001
Mailing address
589 SOUTH STATE STREET, PROVO, UT 84606-5056
(801) 429-2000
(801) 429-2001
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
—
—
122300000X
Dentist
—
—
183500000X
Pharmacist
—
—
207Q00000X
Family Medicine Physician
—
—
207VX0000X
Obstetrics Physician
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1012699
—
UT
Enumeration date
07/17/2006
Last updated
03/27/2025
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