Provider Demographics
NPI:1417988833
Name:SALT LAKE REGIONAL MEDICAL CENTER LP
Entity Type:Organization
Organization Name:SALT LAKE REGIONAL MEDICAL CENTER LP
Other - Org Name:SALT LAKE REGIONAL MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HOSPITAL CEO
Authorized Official - Prefix:
Authorized Official - First Name:DALE
Authorized Official - Middle Name:A
Authorized Official - Last Name:JOHNS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-350-4008
Mailing Address - Street 1:1050 E SOUTH TEMPLE
Mailing Address - Street 2:ATTN: BILLING
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84102-1507
Mailing Address - Country:US
Mailing Address - Phone:801-350-4111
Mailing Address - Fax:801-350-4522
Practice Address - Street 1:1050 E SOUTH TEMPLE
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102-1507
Practice Address - Country:US
Practice Address - Phone:801-350-4008
Practice Address - Fax:801-350-4525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2018-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2007HOSP185282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT=========002Medicaid
UT460003Medicare Oscar/Certification