CONFEDERATED TRIBES OF THE GOSHUTE RESERVATION (NPI# 1003251638) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1003251638 |
| Entity Type | Organization |
| Organization Name | CONFEDERATED TRIBES OF THE GOSHUTE RESERVATION |
| Practice Address |
660 S 200 E Ste 250 Salt Lake City UT 84111-3846 |
| Mailing Address |
660 S 200 E Suite 250 Salt Lake City UT 84111-3835 |
| Practice Telephone | 8013592256 |
| Mailing Telephone | 8013592256 |
| Enumeration Date | 2013-05-09 |
| Last Update Date | 2017-12-21 |
| Authorized Official Name | CRYSTAL CONTRERAS (BILLING) |
| Authorized Official Telephone | 8013592256 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 3336C0002X |
Pharmacy Specialization: Clinic Pharmacy |
Suppliers | ||
| Y | 332800000X | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | 8547079-1704 | UT | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| PK | 2140406 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396199972 | Confederated Tribes of The Goshute Reservation | Clinic/Center | Hc 61 Box 6104, Ibapah, UT 84034-6003 | 2016-04-20 |
| 1750510277 | Confederated Tribes of The Goshute Reservation | General Practice | 195 Tribal Center Rd, Ibapah, UT 84034 | 2009-07-06 |
| 1194189233 | Confederated Tribes of The Goshute Reservation | Clinic/Center | 660 S 200 E, Suite 250, Salt Lake City, UT 84111-3835 | 2016-04-05 |
| 1265892012 | Confederated Tribes of The Goshute Reservation | Clinical Medical Laboratory | 660 S 200 E Ste 250, Salt Lake City, UT 84111-3846 | 2016-03-07 |
| 1003275280 | Confederated Tribes of The Goshute Reservation | Clinic/Center | 660 S 200 E Ste 250, Salt Lake City, UT 84111-3846 | 2016-02-17 |
| 1467811562 | Confederated Tribes of The Goshute Reservation | Pharmacy | 660 S 200 E, Salt Lake City, UT 84111-3835 | 2016-02-17 |
| 1174969125 | Confederated Tribes of The Goshute Reservation | Clinic/Center | 660 S 200 E Ste 250, Salt Lake City, UT 84111-3846 | 2013-05-17 |
| 1992141964 | Confederated Tribes of The Goshute Reservation | Clinic/Center | 660 S 200 E, Suite 250, Salt Lake City, UT 84111-3835 | 2013-05-17 |
| Street Address |
660 S 200 E STE 250 |
| City | SALT LAKE CITY |
| State | UT |
| Zip Code | 84111-3846 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396844049 | David J Hadley | Dentist | 660 S 200 E Ste 250, Salt Lake City, UT 84111-3846 | 2006-09-21 |
| 1669071395 | Megan Sonja Sullivan | Nurse Practitioner | 660 S 200 E Ste 250, Salt Lake City, UT 84111-3846 | 2020-10-23 |
| 1386253532 | Kelly Dorthea Hollie | Social Worker | 660 S 200 E Ste 250, Salt Lake City, UT 84111-3846 | 2020-07-23 |
| 1558903617 | Natalie Linares | Dental Hygienist | 660 S 200 E Ste 250, Salt Lake City, UT 84111-3846 | 2019-10-10 |
| 1174175426 | Michael Stephen Miles | Physician Assistant | 660 S 200 E Ste 250, Salt Lake City, UT 84111-3846 | 2019-07-16 |
| 1003474602 | Elizabeth Neilson | Physical Therapist | 660 S 200 E Ste 250, Salt Lake City, UT 84111-3846 | 2019-05-30 |
| 1598238594 | Elizabeth Annas | Physical Therapist | 660 S 200 E Ste 250, Salt Lake City, UT 84111-3846 | 2019-01-02 |
| 1265929640 | Daniel Rodriguez | Dentist | 660 S 200 E Ste 250, Salt Lake City, UT 84111-3846 | 2018-04-20 |
| 1265892012 | Confederated Tribes of The Goshute Reservation | Clinical Medical Laboratory | 660 S 200 E Ste 250, Salt Lake City, UT 84111-3846 | 2016-03-07 |
| 1003275280 | Confederated Tribes of The Goshute Reservation | Clinic/Center | 660 S 200 E Ste 250, Salt Lake City, UT 84111-3846 | 2016-02-17 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316551336 | Mary Ann Rush | Case Manager/Care Coordinator | 334 E. 100 S., Slc, UT 84111 | 2020-09-08 |
| 1790396554 | Stephanie G Mishenko | Military Health Care Provider | 344e 100s, Slc, UT 84111 | 2020-08-13 |
| 1386264802 | Mckensee M Carter | Case Manager/Care Coordinator | 334 E 100 S, Salt Lake City, UT 84111 | 2020-04-24 |
| 1316421761 | Community Health Centers, Inc. | Social Worker | 610 S 200 E Ste #b, Salt Lake City, UT 84111 | 2018-09-21 |
| 1528545506 | Lauren Brittney Harman | Case Manager/Care Coordinator | 344 E. 100 S., Salt Lake City, UT 84111 | 2018-07-23 |
| 1851896484 | Shivani Chowdhary | Dentist | 370 E South Temple Ste 350, Salt Lake City, UT 84111 | 2018-03-26 |
| 1801390661 | Jaylee Marie Watman | Case Manager/Care Coordinator | 344 E. 100 S. Ste 301, Salt Lake City, UT 84111 | 2018-03-19 |
| 1467963918 | Victoira Julia Graham | Case Management | 344 East 100 South Ste 301, Salt Lake City, UT 84111 | 2017-10-23 |
| 1750805404 | Kayla Hymas | Behavioral Analyst | 243 E. 400 S., Slc, UT 84111 | 2017-08-02 |
| 1134643224 | Julie Peaslee | Counselor | 275 E South Temple Ste 110, Salt Lake City, UT 84111 | 2017-07-31 |
| Find all providers in zip 84111 | ||||
| Taxonomy Code | 332800000X |
| Grouping | Suppliers |
| Classification | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy |
| An Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy means a pharmacy operated by the Indian Health Service, an Indian tribe or tribal organization, or an urban Indian organization, all of which are defined in Section 4 of the Indian Health Care Improvement Act, 25 U.S.C. 1603. |
| Notes: Source: The Medicare Prescription Drug, Improvement and Modernization Act of 2003 [1/1/2006: new] |
| City | SALT LAKE CITY |
| Zip Code | 84111 |
Please comment or provide details below to improve the information on CONFEDERATED TRIBES OF THE GOSHUTE RESERVATION.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.