Provider Demographics
NPI:1760650527
Name:COLUMBIA OGDEN REGIONAL
Entity Type:Organization
Organization Name:COLUMBIA OGDEN REGIONAL
Other - Org Name:COLUMBIA OGDEN SENIOR HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:HALE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-479-2033
Mailing Address - Street 1:P O BOX 71128
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84171-0128
Mailing Address - Country:US
Mailing Address - Phone:801-352-2700
Mailing Address - Fax:801-352-0400
Practice Address - Street 1:5405 S 500 E
Practice Address - Street 2:SUITE 110
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84405-6957
Practice Address - Country:US
Practice Address - Phone:801-475-4379
Practice Address - Fax:801-475-4381
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HCA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-14
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT932667911204207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Single Specialty