Provider Demographics
NPI:1811037484
Name:DAVIS HOSPITAL & MEDICAL CENTER LP
Entity Type:Organization
Organization Name:DAVIS HOSPITAL & MEDICAL CENTER LP
Other - Org Name:DAVIS HOSPITAL & MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HOSPITAL CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:JENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-807-7157
Mailing Address - Street 1:1600 WEST ANTELOPE DRIVE
Mailing Address - Street 2:ATTN: BILLING
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84041-1142
Mailing Address - Country:US
Mailing Address - Phone:801-807-1000
Mailing Address - Fax:801-807-7045
Practice Address - Street 1:1600 W ANTELOPE DR
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-1142
Practice Address - Country:US
Practice Address - Phone:801-807-1000
Practice Address - Fax:801-807-7623
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DAVIS HOSPITAL & MEDICAL CENTER LP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-06
Last Update Date:2018-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273Y00000XHospital UnitsRehabilitation Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT=========001Medicaid
UT46T041Medicare Oscar/Certification