Fourth Street Clinic

LBN: Wasatch Homeless Health Care, Inc.
Fourth Street Clinic is an health care organization with primary practice located at 409 W 400 S , Salt Lake City UT 84101-1135. The organization recently has only one registered license in Ambulatory Health Care Facilities / Federally Qualified Health Center (FQHC), which is considered as the primary health care specialty. Wasatch Homeless Health Care, Inc. can be contacted via phone (801) 364-0058, or through Emerson, Janida via phone (801) 364-0058.

Contact Information

Primary practice address
409 W 400 S Salt Lake City UT 84101-1135
Phone: (801) 364-0058
Fax: (801) 364-0161
Website:
Map and Directions
Authorized official contact:
Name: Emerson, Janida
Phone: (801) 364-0058

Health care specialties

SpecialtyCodeLicense #State
Ambulatory Health Care Facilities / Federally Qualified Health Center (FQHC) 261QF0400X

Profile Details

NPI number 1528128899
LBN Legal business name Wasatch Homeless Health Care, Inc.
DBA Doing business as Fourth Street Clinic
Authorized official Emerson, Janida
Entity Organization
Organization subpart 1 No
Enumeration date Dec 9th, 2006
Last updated Nov 24th, 2020 - about 4 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1528128899 NPPES
Utah Other 201375 BLACK LUNG
Utah MEDICAID W0210 BLACK LUNG

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