Provider Demographics
NPI:1124208947
Name:DESERT VALLEY DIALYSIS CENTER
Entity Type:Organization
Organization Name:DESERT VALLEY DIALYSIS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:L
Authorized Official - Last Name:HEMMING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-581-8573
Mailing Address - Street 1:PO BOX 27071
Mailing Address - Street 2:
Mailing Address - City:SLC
Mailing Address - State:UT
Mailing Address - Zip Code:84127-0071
Mailing Address - Country:US
Mailing Address - Phone:801-581-8578
Mailing Address - Fax:801-581-4750
Practice Address - Street 1:350 FALCON RIDGE PKWY STE 700
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:NV
Practice Address - Zip Code:89027-8880
Practice Address - Country:US
Practice Address - Phone:801-581-8578
Practice Address - Fax:801-581-4750
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-08
Last Update Date:2013-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV292532Medicare Oscar/Certification