Provider Demographics
NPI:1144490160
Name:JORDAN VALLEY MEDICAL CENTER LP
Entity type:Organization
Organization Name:JORDAN VALLEY MEDICAL CENTER LP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HOSPITAL CEO
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-561-8888
Mailing Address - Street 1:3580 W 9000 S
Mailing Address - Street 2:ATTN: BILLING
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84088-8812
Mailing Address - Country:US
Mailing Address - Phone:801-561-8888
Mailing Address - Fax:801-569-8723
Practice Address - Street 1:3580 W 9000 S
Practice Address - Street 2:
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84088-8812
Practice Address - Country:US
Practice Address - Phone:801-561-8888
Practice Address - Fax:801-569-8723
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JORDAN VALLEY MEDICAL CENTER LP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-05
Last Update Date:2018-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2008-HOSP-810273Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273Y00000XHospital UnitsRehabilitation Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
103002113104OtherIHC SELECT HEALTH
95900OtherPEHP
213091OtherALTIUS
103002113105OtherIHC SELECT HEALTH ER
=========01001OtherBLUE CROSS BLUE SHIELD
95900OtherPEHP
UT=========001Medicaid
=========01001OtherBLUE CROSS BLUE SHIELD