Healthcare Provider Details

I. General information

NPI: 1851455224
Provider Name (Legal Business Name): BONNEVILLE DIALYSIS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5575 S 500 E
OGDEN UT
84405-6907
US

IV. Provider business mailing address

PO BOX 27071
SALT LAKE CITY UT
84127-0071
US

V. Phone/Fax

Practice location:
  • Phone: 801-479-0351
  • Fax: 801-476-1766
Mailing address:
  • Phone: 801-581-8578
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2472R0900X
TaxonomyRenal Dialysis Technician
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code246ZN0300X
TaxonomyNephrology Specialist/Technologist
License Number
License Number StateNULL

VIII. Authorized Official

Name: STEVE SUTCH
Title or Position: CLINICAL ADMIN. MANAGER
Credential:
Phone: 801-587-7606