Provider Demographics
NPI:1669446563
Name:CACHE VALLEY SPECIALTY HOSPITAL
Entity Type:Organization
Organization Name:CACHE VALLEY SPECIALTY HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:S
Authorized Official - Last Name:GEARY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-713-9582
Mailing Address - Street 1:2380 N 400 E
Mailing Address - Street 2:
Mailing Address - City:NORTH LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84341-6000
Mailing Address - Country:US
Mailing Address - Phone:435-713-9700
Mailing Address - Fax:435-753-8005
Practice Address - Street 1:2380 N 400 E
Practice Address - Street 2:
Practice Address - City:NORTH LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84341-1749
Practice Address - Country:US
Practice Address - Phone:435-713-9700
Practice Address - Fax:435-753-8005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-15
Last Update Date:2013-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2005-HOSP-14503282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT8059105Medicaid
WY115751500Medicaid
UT8059105Medicaid
UT460054Medicare Oscar/Certification
WY115751500Medicaid