WASATCH HOMELESS HEALTH CARE, INC. (NPI# 1528128899) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1528128899 |
| Entity Type | Organization |
| Organization Name | WASATCH HOMELESS HEALTH CARE, INC. |
| Other Organization Name | FOURTH STREET CLINIC |
| Practice Address |
409 W 400 S Salt Lake City UT 84101-1135 |
| Practice Telephone | 8013640058 |
| Practice Fax Number | 8013640161 |
| Mailing Telephone | 8013640058 |
| Mailing Fax Number | 8013640161 |
| Enumeration Date | 2006-12-09 |
| Last Update Date | 2014-01-22 |
| Authorized Official Name | MS. MELANIE J TAYLOR (COO) |
| Authorized Official Telephone | 8013640058 |
| Authorized Official Credential | MSC |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QF0400X |
Clinic/Center Specialization: Federally Qualified Health Center (FQHC) |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| UT | W0210 | 05 | |
| UT | BLACK LUNG | 201375 | 01 |
| Other Name | Type Code |
|---|---|
| Fourth Street Clinic | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720270275 | Wasatch Homeless Health Care, Inc. | Pharmacy | 409 West 400 South, Salt Lake, UT 84101-8410 | 2007-08-17 |
| 1043865074 | Wasatch Homeless Health Care, Inc. | Pharmacy | 409 West 400 South, Salt Lake, UT 84101 | 2019-08-06 |
| Street Address |
409 W 400 S |
| City | SALT LAKE CITY |
| State | UT |
| Zip Code | 84101-1135 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992261077 | Samantha Lee Stacks | Nurse Practitioner | 409 W 400 S, Salt Lake City, UT 84101-1135 | 2019-02-14 |
| 1659850287 | Michael Dressman | Case Manager/Care Coordinator | 409 W 400 S, Salt Lake City, UT 84101 | 2018-08-14 |
| 1285164236 | Ryan Cochrane | Registered Nurse | 409 W 400 S, Salt Lake City, UT 84101-1135 | 2017-06-13 |
| 1992165054 | Patricia Smith | Registered Nurse | 409 W 400 S, Salt Lake City, UT 84101-1135 | 2016-03-02 |
| 1225497910 | Emily Horton | Social Worker | 409 W 400 S, Salt Lake City, UT 84101-1135 | 2016-02-23 |
| 1225496391 | Christopher Lee Smith | Nurse Practitioner | 409 W 400 S, Salt Lake City, UT 84101-1135 | 2016-02-04 |
| 1982097127 | Jamie Leigh Bustamante | Psychologist | 409 W 400 S, Salt Lake City, UT 84101-1135 | 2015-03-12 |
| 1902202807 | Jamie Kuttler | Physician Assistant | 409 W 400 S, Salt Lake City, UT 84101-1135 | 2014-11-05 |
| 1326482803 | Joel Wecker | Family Medicine | 409 W 400 S, Salt Lake City, UT 84101-1135 | 2013-04-26 |
| 1598023871 | Christopher Belknap | Family Medicine | 409 W 400 S, Salt Lake City, UT 84101-1135 | 2012-04-24 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053804237 | Holly Smith | Registered Nurse | 1020 S Main Street, Salt Lake City, UT 84101 | 2018-06-12 |
| 1174999627 | Justin Williams | Social Worker | 155 W. 300 S., Salt Lake City, UT 84101 | 2015-08-19 |
| 1902291842 | Daryl Ray Ezidore | Student in an Organized Health Care Education/Training Program | 100 South 344 East, Salt Lake City, UT 84101 | 2015-03-30 |
| 1104190859 | Luxottica of America Inc. | Eyewear Supplier (Equipment, not the service) | 50 S Main St Ste 115, Salt Lake City, UT 84101 | 2012-02-28 |
| 1366713307 | Gonstead Family Chiropractic | Chiropractor | 1154 S. 300 W., Suite C, Salt Lake City, UT 84101 | 2012-01-23 |
| 1659544880 | Jeffrey Daniel | Registered Nurse | 404 South 400 West, Salt Lake City, UT 84101 | 2008-04-09 |
| 1306030580 | Christopher Dean Chapman | Chiropractor | 345 W 100 S Ste 6c, Salt Lake City, UT 84101 | 2007-08-30 |
| 1689713497 | Walter Landon Bye | Dentist | 15 West South Temple, Gateway Tower West Suite 440, Salt Lake City, UT 84101 | 2007-02-06 |
| 1154403152 | Allison Miller Gardner | Physical Therapist | 84 West 700 South, Salt Lake City, UT 84101 | 2006-10-19 |
| 1780655407 | Frederick Van Der Veur | Social Worker | 1020 South Main Street, 242, Salt Lake City, UT 84101 | 2006-01-30 |
| Find all providers in zip 84101 | ||||
| Taxonomy Code | 261QF0400X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Federally Qualified Health Center (FQHC) |
| Definition to come... |
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| 1417305087 | Bear Lake Community Health Centers | Clinic/Center | 944 S State Highway 89, Logan, UT 84321-5436 | 2016-05-24 |
| 1780090944 | Southwest Utah Community Health Center, Inc. | Clinic/Center | 391 North 200 West, Hurricane, UT 84737-1616 | 2014-07-09 |
| 1548588247 | Southwest Utah Community Health Center, Inc | Clinic/Center | 74 W. Harding Ave, Cedar City, UT 84720 | 2010-05-06 |
| 1689754475 | Bear Lake Community Health Center | Clinic/Center | 325 W. Logan Hwy, Garden City, UT 84028-0328 | 2006-10-16 |
| 1942317722 | Green River Medical Center Inc | Clinic/Center | 585 West Main St., Box 417, Green River, UT 84525-0417 | 2006-08-25 |
| 1659358687 | Southwest Utah Community Health Center | Clinic/Center | 25 N 100 E, Suite 102, St George, UT 84770 | 2005-12-30 |
| 1366447112 | Community Health Centers Inc. | Clinic/Center | 1365 W 1000 N, Slc, UT 84116-1654 | 2005-06-17 |
| 1477558237 | Community Health Centers Inc. | Clinic/Center | 8446 Harrison St, Midvale, UT 84047-3568 | 2005-06-17 |
| 1144834771 | Carbon Medical Service Assocation, Incorporated | Clinic/Center | 305 Center St, East Carbon, UT 84520-7726 | 2020-09-01 |
| Find all providers with the same taxonomy | ||||
| City | SALT LAKE CITY |
| Zip Code | 84101 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.