Provider Demographics
NPI:1487498978
Name:MILFORD MEMORIAL HOSPITAL
Entity type:Organization
Organization Name:MILFORD MEMORIAL HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:TYLER
Authorized Official - Middle Name:
Authorized Official - Last Name:MOSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-438-7209
Mailing Address - Street 1:PO BOX 640
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:UT
Mailing Address - Zip Code:84751-0640
Mailing Address - Country:US
Mailing Address - Phone:435-387-2411
Mailing Address - Fax:
Practice Address - Street 1:125 S 900 W
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84104-1125
Practice Address - Country:US
Practice Address - Phone:801-363-6340
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-20
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT2024-NCF-F23-106970OtherLICENSURE