Provider Demographics
NPI:1164469243
Name:NORTHERN UTAH HEALTHCARE CORPORATION
Entity Type:Organization
Organization Name:NORTHERN UTAH HEALTHCARE CORPORATION
Other - Org Name:ST. MARK'S HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:HERRON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-268-7092
Mailing Address - Street 1:1200 E 3900 S
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84124-1300
Mailing Address - Country:US
Mailing Address - Phone:801-268-7111
Mailing Address - Fax:801-270-3489
Practice Address - Street 1:1200 E 3900 S
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124-1300
Practice Address - Country:US
Practice Address - Phone:801-268-7111
Practice Address - Fax:801-270-3489
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-31
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY112938400Medicaid
OR292841Medicaid
WA3021219Medicaid
UT62133082902001OtherBLUE CROSS
NV1189157Medicaid
ID805001700Medicaid
MT0410907Medicaid
AKHS9UTMedicaid
CAXHSP33137Medicaid
TX158945901Medicaid
AZ477829Medicaid
UT=========021Medicaid
WY112938400Medicaid
CAXHSP33137Medicaid