Healthcare Provider Details

I. General information

NPI: 1730233735
Provider Name (Legal Business Name): TOOELE HOSPITAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2055 N MAIN ST
TOOELE UT
84074-9819
US

IV. Provider business mailing address

2055 N MAIN ST
TOOELE UT
84074-9819
US

V. Phone/Fax

Practice location:
  • Phone: 435-843-3677
  • Fax: 435-833-9844
Mailing address:
  • Phone: 435-843-3677
  • Fax: 435-833-9844

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number347246-1206
License Number StateUT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DANIEL L. MARTIN
Title or Position: PHYSICIAN ASSISTANT
Credential: PA-C
Phone: 435-843-3677