Provider Demographics
NPI:1851901870
Name:KPC PROMISE HOSPITAL OF SALT LAKE LLC
Entity Type:Organization
Organization Name:KPC PROMISE HOSPITAL OF SALT LAKE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-987-8100
Mailing Address - Street 1:9 KPC PKWY STE 301
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92879-7102
Mailing Address - Country:US
Mailing Address - Phone:951-782-8812
Mailing Address - Fax:
Practice Address - Street 1:4252 S BIRKHILL BLVD
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-5715
Practice Address - Country:US
Practice Address - Phone:385-425-0050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-04
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336I0012XSuppliersPharmacyInstitutional Pharmacy
No333600000XSuppliersPharmacy