Provider Demographics
NPI:1770626426
Name:DIGNITY HEALTH
Entity type:Organization
Organization Name:DIGNITY HEALTH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-616-5507
Mailing Address - Street 1:3033 N 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85013-4447
Mailing Address - Country:US
Mailing Address - Phone:602-307-2420
Mailing Address - Fax:602-798-9655
Practice Address - Street 1:3001 SAINT ROSE PKWY
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-3839
Practice Address - Country:US
Practice Address - Phone:702-616-5000
Practice Address - Fax:702-616-5511
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DIGNITY HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-14
Last Update Date:2018-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2969HOS10282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1102300Medicaid
NVCC0272OtherBLUE CROSS BLUE SHIELF
NV1202300Medicaid
NV2307549OtherAETNA
NV880455713OtherIRS
NV1002300Medicaid
191301000OtherUS DEPT OF LABOR
880455713890520000OtherTRICARE CHAMPUS
NV880455713OtherIRS
NV1002300Medicaid