Provider Demographics
NPI:1689770356
Name:DIALYSIS PROGRAM PHYSICIANS UNIVERSITY OF UTAH
Entity Type:Organization
Organization Name:DIALYSIS PROGRAM PHYSICIANS UNIVERSITY OF UTAH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:L
Authorized Official - Last Name:HEMMING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-581-8573
Mailing Address - Street 1:PO BOX 841462
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90084-1462
Mailing Address - Country:US
Mailing Address - Phone:801-581-8578
Mailing Address - Fax:801-581-4750
Practice Address - Street 1:515 E 100 S STE 350
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102-3766
Practice Address - Country:US
Practice Address - Phone:801-581-8578
Practice Address - Fax:801-581-4750
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-16
Last Update Date:2022-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTCI6697OtherRR MEDICARE
UTCI6697OtherRR MEDICARE