1548205818 NPI number — DAVIS HOSPITAL & MEDICAL CENTER LP

Table of content: (NPI 1548205818)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548205818 NPI number — DAVIS HOSPITAL & MEDICAL CENTER LP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DAVIS HOSPITAL & MEDICAL CENTER LP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1548205818
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/05/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1600 WEST ANTELOPE DRIVE
Provider Second Line Business Mailing Address:
ATTN: BILLING
Provider Business Mailing Address City Name:
LAYTON
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84041-1142
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-807-1000
Provider Business Mailing Address Fax Number:
801-807-7045

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1600 W ANTELOPE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAYTON
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84041-1142
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-807-1000
Provider Business Practice Location Address Fax Number:
801-807-7045
Provider Enumeration Date:
06/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
JENSEN
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
Authorized Official Title or Position:
HOSPITAL CEO
Authorized Official Telephone Number:
801-807-7001

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  2005HOSP-187 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 500023 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 59252 . This is a "PEHP" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: QM0000022744 . This is a "ALTIUS" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 854673 . This is a "DMBA" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 103002097101 . This is a "SELECT HEALTH PLANS (IHC)" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".




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