Healthcare Provider Details

I. General information

NPI: 1083713598
Provider Name (Legal Business Name): CASTLEVIEW DIALYSIS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 09/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 N HOSPITAL DR STE 1
PRICE UT
84501-4222
US

IV. Provider business mailing address

PO BOX 27071
SALT LAKE CITY UT
84127-0071
US

V. Phone/Fax

Practice location:
  • Phone: 801-637-8696
  • Fax: 801-637-9612
Mailing address:
  • Phone: 801-581-8578
  • Fax: 801-637-9612

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0700X
TaxonomyEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center
License Number2005-ESRD-224
License Number StateUT

VIII. Authorized Official

Name: MR. STEVEN L HEMMING
Title or Position: PROGRAM ADMINISTRATOR
Credential:
Phone: 801-581-8573