ASHLEY VALLEY MEDICAL CENTER LLC — NPI 1104672179 (Licensed & Credentialed Respiratory, Developmental, Rehabilitative & Restorative Service Providers

CMS-1500 Box 24J / 33a • NPI

1104672179

Type 2 Organization (Box 32a/33a)

HIPAA NUCC Taxonomy • CMS Code

225100000X (CMS 65)

Licensed & Credentialed Respiratory, Developmental, Rehabilitative & Restorative Service Providers — Physical Therapist

Box 32 Service Location & ZIP+4

150 W 100 N, VERNAL, UT, 84078-2036

✓ 9-Digit EDI 837 ZIP+4 (84078-2036)

Practice Phone & Referral Fax

(435) 789-3342

Direct NPPES Verification Line

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1104672179 (ASHLEY VALLEY MEDICAL CENTER LLC) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).

CMS Medicare Order & Referring PECOS Eligibility

Institutional Type-2 NPI facilities enroll via CMS-855A institutional provider agreements rather than individual Order & Referring PECOS.

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1104672179` (NPI-2 Organization / Facility)
Provider / Legal Name	ASHLEY VALLEY MEDICAL CENTER LLC
Plain-English Specialty	Licensed & Credentialed Respiratory, Developmental, Rehabilitative & Restorative Service Providers — Physical Therapist NUCC Code: `225100000X` (Physical Therapist)
Certifying / Licensing Body	State Medical / Healthcare Licensing Board & National Specialty Board
Practice Location Address	150 W 100 N, VERNAL, UT, 84078-2036
Practice Telephone / Fax	Tel: (435) 789-3342
Administrative Mailing Address	150 W 100 N, VERNAL, UT, 84078-2036
Enumeration & Last Sync	Enumerated: 2024-04-29 \| CMS Record Updated: 2024-04-29
Authorized Official	CHARLOTTE LAWRENCE (Secretary)

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

150 W 100 N, VERNAL, UT, 84078-2036

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Plain-English Taxonomy & CMS Crosswalk (225100000X)

What Does Taxonomy Code 225100000X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 225100000X translates to:
"Licensed & Credentialed Respiratory, Developmental, Rehabilitative & Restorative Service Providers — Physical Therapist"

CMS-1500 Medicare Specialty Crosswalk: CMS Code 65 (Physical Therapist in Private Practice)
Certifying / Accrediting Authority: State Medical / Healthcare Licensing Board & National Specialty Board
Clinical Scope: Consult a verified Physical Therapist for specialized diagnostic evaluation, treatment planning, and continuity of care.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (ASHLEY VALLEY MEDICAL CENTER LLC)

Typical CPT / Diagnostic Procedures:

Comprehensive Outpatient & Inpatient Clinical Evaluation (CPT 99202–99215)
Diagnostic Workup, Laboratory Ordering & Evidence-Based Care Coordination
Preventive Screening, Patient Counseling & Multidisciplinary Referral

Common Therapeutic Classes:

Evidence-Based Specialty Pharmacotherapy & Preventive Regimens (CMS Part D Standard)

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`225100000X` — Physical Therapist Plain English: Licensed & Credentialed Respiratory, Developmental, Rehabilitative & Restorative Service Providers — Physical Therapist	State: N/A \| License: `Verified` \| Primary: Yes (Primary)
`282N00000X` — General Acute Care Hospital Plain English: Accredited Inpatient Medical & Surgical Hospital (24/7 Emergency & ICU Care)	State: N/A \| License: `Verified` \| Primary: Secondary

Medical Billing, RCM & Hospital Credentialing Teams:

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ASHLEY VALLEY MEDICAL CENTER LLC (NPI #1104672179)