Basic Information
| Provider Information | |||||||||
| NPI: | 1386728665 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SALT LAKE REGIONAL MEDICAL CENTER LP | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | SALT LAKE REGIONAL MEDICAL CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1050 E SOUTH TEMPLE | ||||||||
| Address2: | ATTN: BILLING | ||||||||
| City: | SALT LAKE CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841021507 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8013504111 | ||||||||
| FaxNumber: | 8013504522 | ||||||||
| Practice Location | |||||||||
| Address1: | 1050 E SOUTH TEMPLE | ||||||||
| Address2: | |||||||||
| City: | SALT LAKE CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841021507 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8013504111 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/24/2006 | ||||||||
| LastUpdateDate: | 04/03/2018 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| AuthorizedOfficialLastName: | JOHNS | ||||||||
| AuthorizedOfficialFirstName: | DALE | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | HOSPITAL CEO | ||||||||
| AuthorizedOfficialTelephone: | 8013504008 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | SALT LAKE REGIONAL MEDICAL CENTER LP | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 273Y00000X | Y | Hospital Units | Rehabilitation Unit |
No ID Information.