Provider Demographics
NPI:1497702195
Name:TIMPANOGOS REGIONAL MEDICAL SERVICES, INC.
Entity Type:Organization
Organization Name:TIMPANOGOS REGIONAL MEDICAL SERVICES, INC.
Other - Org Name:TIMPANOGOS REGIONAL HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:N
Authorized Official - Last Name:SQUIRES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-714-6502
Mailing Address - Street 1:750 W 800 N
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84057-3660
Mailing Address - Country:US
Mailing Address - Phone:801-714-6800
Mailing Address - Fax:801-714-6597
Practice Address - Street 1:750 W 800 N
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84057-3660
Practice Address - Country:US
Practice Address - Phone:801-714-6800
Practice Address - Fax:801-714-6597
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT87033304822001OtherBLUE CROSS
AZ886418Medicaid
=========840574000OtherTRICARE
AZ886418Medicaid
UT=========013Medicaid