| Organization Name: | SOUTHERN UTE TRIBE |
| NPI Number: | 1407883309 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | TEENA JEFFERSON (BUSINESS OFFICE) |
| Mailing Address: | 123 Weeminuche Ave. Ignacio |
| State: | CO US |
| Postal Code: | 811370899 |
| Phone Number: | 9705634581 |
| Fax Number: | 9705630208 |
| NPI Enumeration Date: | 06/27/2006 |
| NPI Last Update Date: | 09/19/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP0904X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Public Health, Federal |
| Taxonomy Definition: | |