Provider Demographics
NPI:1396036695
Name:JORDAN VALLEY MEDICAL CENTER LP
Entity Type:Organization
Organization Name:JORDAN VALLEY MEDICAL CENTER LP
Other - Org Name:JORDAN VALLEY MEDICAL CENTER
Other - Org Type:Doing Business As
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:801-561-8888
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:801-964-3100
Practice Address - Fax:801-964-3247
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JORDAN VALLEY MEDICAL CENTER LP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-04-21
Last Update Date:2018-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT46S051Medicare Oscar/Certification