| Organization Name: | COALVILLE HEALTH CENTER |
| NPI Number: | 1164676698 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | D. WAIN ALLEN (OWNER) |
| Mailing Address: | 142 S 50 East Suite 102 Pob 865 Coalville |
| State: | UT US |
| Postal Code: | 840170865 |
| Phone Number: | 4353364403 |
| Fax Number: | 4353365570 |
| NPI Enumeration Date: | 11/11/2008 |
| NPI Last Update Date: | 11/11/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QM1300X |
| License Number: | 1713511205 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | UT |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Multi-Specialty |
| Taxonomy Definition: | |