Provider Demographics
NPI:1770821571
Name:LONE PEAK HOSPITAL, INC.
Entity Type:Organization
Organization Name:LONE PEAK HOSPITAL, INC.
Other - Org Name:LONE PEAK HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCMINN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-545-8014
Mailing Address - Street 1:11925 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-7735
Mailing Address - Country:US
Mailing Address - Phone:801-545-8000
Mailing Address - Fax:
Practice Address - Street 1:11925 S STATE ST
Practice Address - Street 2:
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-7735
Practice Address - Country:US
Practice Address - Phone:801-545-8000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-29
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT460060Medicare Oscar/Certification