Provider Demographics
NPI:1548205818
Name:DAVIS HOSPITAL & MEDICAL CENTER LP
Entity Type:Organization
Organization Name:DAVIS HOSPITAL & MEDICAL CENTER LP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HOSPITAL CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:JENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-807-7001
Mailing Address - Street 1:1600 WEST ANTELOPE DRIVE
Mailing Address - Street 2:ATTN: BILLING
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84041-1142
Mailing Address - Country:US
Mailing Address - Phone:801-807-1000
Mailing Address - Fax:801-807-7045
Practice Address - Street 1:1600 W ANTELOPE DR
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-1142
Practice Address - Country:US
Practice Address - Phone:801-807-1000
Practice Address - Fax:801-807-7045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-19
Last Update Date:2018-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2005HOSP-187282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT500023OtherUNITED HEALTH CARE
UT59252OtherPEHP
UTQM0000022744OtherALTIUS
UT854673OtherDMBA
UT103002097101OtherSELECT HEALTH PLANS (IHC)
UT=========OtherTRICARE
UT854673OtherDMBA
UT=========DMCOtherEMIA
UT103002097101OtherSELECT HEALTH PLANS (IHC)
UT=========001Medicaid