Provider Demographics
NPI:1144834771
Name:CARBON MEDICAL SERVICE ASSOCIATION, INCORPORATED
Entity type:Organization
Organization Name:CARBON MEDICAL SERVICE ASSOCIATION, INCORPORATED
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-888-4411
Mailing Address - Street 1:PO BOX 460
Mailing Address - Street 2:
Mailing Address - City:SUNNYSIDE
Mailing Address - State:UT
Mailing Address - Zip Code:84539-0460
Mailing Address - Country:US
Mailing Address - Phone:435-630-4332
Mailing Address - Fax:
Practice Address - Street 1:305 CENTER ST
Practice Address - Street 2:
Practice Address - City:EAST CARBON
Practice Address - State:UT
Practice Address - Zip Code:84520-7726
Practice Address - Country:US
Practice Address - Phone:435-630-4332
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CARBON MEDICAL SERVICE ASSOCATION, INCORPORATED
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-09-01
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)