Provider Demographics
NPI:1942693213
Name:PAIUTE INDIAN TRIBE OF UTAH
Entity type:Organization
Organization Name:PAIUTE INDIAN TRIBE OF UTAH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:TRIBAL ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SHANE
Authorized Official - Middle Name:
Authorized Official - Last Name:PARASHONTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-586-1112
Mailing Address - Street 1:440 N PAIUTE DR
Mailing Address - Street 2:
Mailing Address - City:CEDAR CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84721-6181
Mailing Address - Country:US
Mailing Address - Phone:435-586-1112
Mailing Address - Fax:435-867-2658
Practice Address - Street 1:376 N PAIUTE DR
Practice Address - Street 2:
Practice Address - City:CEDAR CITY
Practice Address - State:UT
Practice Address - Zip Code:84721-6181
Practice Address - Country:US
Practice Address - Phone:435-867-2650
Practice Address - Fax:435-867-2658
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-11
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental