Provider Demographics
NPI:1609934132
Name:PIONER VALLEY HOSPITAL INC
Entity type:Organization
Organization Name:PIONER VALLEY HOSPITAL INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JARED
Authorized Official - Middle Name:
Authorized Official - Last Name:SPACKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-964-3104
Mailing Address - Street 1:3336 PIONEER PKWY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WEST VALLEY CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84120-2000
Mailing Address - Country:US
Mailing Address - Phone:801-964-3948
Mailing Address - Fax:801-964-3635
Practice Address - Street 1:3336 PIONEER PKWY
Practice Address - Street 2:SUITE 302
Practice Address - City:WEST VALLEY CITY
Practice Address - State:UT
Practice Address - Zip Code:84120-2000
Practice Address - Country:US
Practice Address - Phone:801-964-3763
Practice Address - Fax:801-964-3538
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty