Healthcare Provider Details

I. General information

NPI: 1013107838
Provider Name (Legal Business Name): TOOELE HOSPITAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2007
Last Update Date: 09/30/2020
Certification Date: 09/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2055 N MAIN ST
TOOELE UT
84074-9819
US

IV. Provider business mailing address

PO BOX 847226
DALLAS TX
75284-7226
US

V. Phone/Fax

Practice location:
  • Phone: 435-843-3600
  • Fax:
Mailing address:
  • Phone: 435-843-3600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number2500-HOSP-14233
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number2500-HOSP-14233
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number2500-HOSP-14233
License Number StateUT

VIII. Authorized Official

Name: RANDY MICHAEL COOPER
Title or Position: SVP FINANCE OPERATIONS/AO
Credential:
Phone: 615-221-3840