Basic Information
| Provider Information | |||||||||
| NPI: | 1548205818 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DAVIS HOSPITAL & MEDICAL CENTER LP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1600 WEST ANTELOPE DRIVE | ||||||||
| Address2: | ATTN: BILLING | ||||||||
| City: | LAYTON | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840411142 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8018071000 | ||||||||
| FaxNumber: | 8018077045 | ||||||||
| Practice Location | |||||||||
| Address1: | 1600 W ANTELOPE DR | ||||||||
| Address2: | |||||||||
| City: | LAYTON | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840411142 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8018071000 | ||||||||
| FaxNumber: | 8018077045 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/19/2006 | ||||||||
| LastUpdateDate: | 04/05/2018 | ||||||||
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| AuthorizedOfficialLastName: | JENSEN | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
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| AuthorizedOfficialTitleorPosition: | HOSPITAL CEO | ||||||||
| AuthorizedOfficialTelephone: | 8018077001 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 2005HOSP-187 | UT | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 500023 | 01 | UT | UNITED HEALTH CARE | OTHER | 59252 | 01 | UT | PEHP | OTHER | QM0000022744 | 01 | UT | ALTIUS | OTHER | 854673 | 01 | UT | DMBA | OTHER | 103002097101 | 01 | UT | SELECT HEALTH PLANS (IHC) | OTHER |