Organization
ENTERPRISE VALLEY MEDICAL CLINIC, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. C.J. HANSEN (EXECUTIVE DIRECTOR)
(435) 878-2281
Entity
Organization
Contact information
Practice address
223 SOUTH 200 EAST, ENTERPRISE, UT 84725-0370
(435) 878-2281
(435) 878-2434
Mailing address
PO BOX 370, ENTERPRISE, UT 84725-0370
(435) 878-2281
(435) 878-2434
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05883
—
UT
Enumeration date
10/31/2006
Last updated
08/22/2020
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