Provider Demographics
NPI:1649089814
Name:HIGH DESERT RENAL PC
Entity type:Organization
Organization Name:HIGH DESERT RENAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PACE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROMNEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:208-705-3002
Mailing Address - Street 1:1751 E AUBURN RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-5514
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1675 N FREEDOM BLVD STE 15
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-6909
Practice Address - Country:US
Practice Address - Phone:855-759-7365
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-02
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment