Healthcare Provider Details

I. General information

NPI: 1760650527
Provider Name (Legal Business Name): COLUMBIA OGDEN REGIONAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2008
Last Update Date: 02/18/2021
Certification Date: 02/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5405 S 500 E SUITE 110
OGDEN UT
84405-6957
US

IV. Provider business mailing address

P O BOX 71128
SALT LAKE CITY UT
84171-0128
US

V. Phone/Fax

Practice location:
  • Phone: 801-475-4379
  • Fax: 801-475-4381
Mailing address:
  • Phone: 801-352-2700
  • Fax: 801-352-0400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number932667911204
License Number StateUT

VIII. Authorized Official

Name: MICHAEL J HALE
Title or Position: CFO
Credential:
Phone: 801-479-2033