Healthcare Provider Details

I. General information

NPI: 1528066875
Provider Name (Legal Business Name): BEAVER VALLEY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2005
Last Update Date: 05/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1109 N 100TH W
BEAVER UT
84713-1670
US

IV. Provider business mailing address

PO BOX 1670 1109 N 100 W
BEAVER UT
84713-1670
US

V. Phone/Fax

Practice location:
  • Phone: 435-438-7100
  • Fax: 435-438-7166
Mailing address:
  • Phone: 435-438-7100
  • Fax: 435-438-7166

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code275N00000X
TaxonomyMedicare Defined Swing Bed Hospital Unit
License Number2006-HOSP-167
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number2004-HOSP-167
License Number StateUT

VIII. Authorized Official

Name: MR. CRAIG VAL DAVIDSON
Title or Position: ADMINISTRATOR
Credential:
Phone: 438-438-7100