Provider Demographics
NPI:1366440620
Name:JORDAN VALLEY MEDICAL CENTER LP
Entity Type:Organization
Organization Name:JORDAN VALLEY MEDICAL CENTER LP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HOSPITAL CEO
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-964-3800
Mailing Address - Street 1:3460 S PIONEER PKWY
Mailing Address - Street 2:ATTN: BILLING
Mailing Address - City:WEST VALLEY CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84120-2049
Mailing Address - Country:US
Mailing Address - Phone:801-964-3100
Mailing Address - Fax:801-964-3247
Practice Address - Street 1:3460 PIONEER PKWY
Practice Address - Street 2:
Practice Address - City:WEST VALLEY CITY
Practice Address - State:UT
Practice Address - Zip Code:84120-2049
Practice Address - Country:US
Practice Address - Phone:801-964-3122
Practice Address - Fax:801-964-3112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-11
Last Update Date:2018-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2005HOSP811282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
95900OtherPEHP
103002113105OtherIHC SELECT HEALTH ER
103002113104OtherIHC SELECT HEALTH
UT310486OtherALTIUS
95900OtherPEHP
103002113105OtherIHC SELECT HEALTH ER
UT=========001Medicaid
UT=========001Medicaid