Provider Demographics
NPI:1609353994
Name:ANTHEM DIALYSIS LLC
Entity Type:Organization
Organization Name:ANTHEM DIALYSIS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:FLINDERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-917-9000
Mailing Address - Street 1:942 FRANCIS CIR
Mailing Address - Street 2:
Mailing Address - City:KAYSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84037-9661
Mailing Address - Country:US
Mailing Address - Phone:801-917-9000
Mailing Address - Fax:
Practice Address - Street 1:1213 FLINT MEADOW DR STE 1B
Practice Address - Street 2:
Practice Address - City:KAYSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84037-6833
Practice Address - Country:US
Practice Address - Phone:385-420-7500
Practice Address - Fax:385-420-7501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-19
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2472R0900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, OtherRenal DialysisGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1609353994Medicaid