1588641088 NPI number — ZION HEALTHCARE COMPLEX

Table of content: (NPI 1588641088)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588641088 NPI number — ZION HEALTHCARE COMPLEX

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ZION HEALTHCARE COMPLEX
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:
1588641088
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5007 S MISSION DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT JOSEPH
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64505-9404
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
816-232-9573
Provider Business Mailing Address Fax Number:
816-232-9596

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
416 N STATE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HURRICANE
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84737-1875
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
435-635-9833
Provider Business Practice Location Address Fax Number:
435-635-9842
Provider Enumeration Date:
12/27/2005

Additional Information

Authorized Official

Authorized Official Last Name:
KELSO
Authorized Official First Name:
GARY
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
816-232-9573

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  2005 NCF 471 , 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: 742561471013 , issued by the state of ( UT ) . This identifiers is of the category "MEDICAID".




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