1164469243 NPI number — NORTHERN UTAH HEALTHCARE CORPORATION

Table of content: (NPI 1164469243)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164469243 NPI number — NORTHERN UTAH HEALTHCARE CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTHERN UTAH HEALTHCARE CORPORATION
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:
ST. MARK'S HOSPITAL
Provider Other Organization Name Type Code:
3
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:
1164469243
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/07/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1200 E 3900 S
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SALT LAKE CITY
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84124-1300
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-268-7111
Provider Business Mailing Address Fax Number:
801-270-3489

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1200 E 3900 S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SALT LAKE CITY
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84124-1300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-268-7111
Provider Business Practice Location Address Fax Number:
801-270-3489
Provider Enumeration Date:
05/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HERRON
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
L.
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
801-268-7092

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 112938400 , issued by the state of ( WY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 292841 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3021219 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 62133082902001 . This is a "BLUE CROSS" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 1189157 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 805001700 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0410907 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".
  • Identifier: HS9UT , issued by the state of ( AK ) . This identifiers is of the category "MEDICAID".
  • Identifier: XHSP33137 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 158945901 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 477829 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




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