Provider Demographics
NPI:1730835455
Name:SPECTRUM SUPPORT SERVICES
Entity type:Organization
Organization Name:SPECTRUM SUPPORT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:MEEKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-621-1668
Mailing Address - Street 1:205 E 1100 S
Mailing Address - Street 2:
Mailing Address - City:VERNAL
Mailing Address - State:UT
Mailing Address - Zip Code:84078-4784
Mailing Address - Country:US
Mailing Address - Phone:435-621-1668
Mailing Address - Fax:
Practice Address - Street 1:205 E 1100 S
Practice Address - Street 2:
Practice Address - City:VERNAL
Practice Address - State:UT
Practice Address - Zip Code:84078-4784
Practice Address - Country:US
Practice Address - Phone:435-621-1668
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-22
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health