UBMC Online Payment Center
Welcome to Uintah Basin Medical Center Online Payment Center. You may pay your hospital bills here by credit card.
For your convenience please fill out the payment form below. All information will be kept secure and confidential. For more information you may call our business office during working hours at 435-725-2060.
You may make payments to Uintah Basin Medical Center using your credit card information. All payments are via secure server. Thank you for allowing us to serve you.
Name Of Patient
Name of Patient Treated.
Invoice Number. (Should Be Located On Your Bill)
Name of Payor
Payor's Name on Credit Card or Checking Account.
Address Where Your Credit Card or Bank Account Statements Are Mailed.
City, State, Zip
Please Include Your City, State, and Five Digit Zip Code.
Your E-Mail Address
Please Provide An E-mail Address.
Amount of Your Payment
Please Specify How Much You Are Paying. Please Use Dollars and Cents.
Credit Card Type
Select If You Are Paying By Credit Card.
Credit Card Number
Input The 16 Digit Number Just As It Appears On Card.
Credit Card Expiration Date
Card Verification Number
For Visa, MasterCard, and Discover cards, the Card Verification Number is the last three digits printed on the back of your card in the signature panel. For American Express, this number is found on the front of your American Express card above the last few embossed numbers.
Comments Or Messages Related To Your Payment
Are you a charitable organization?