Healthcare Provider Details

I. General information

NPI: 1851364947
Provider Name (Legal Business Name): TOOELE HOSPITAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2006
Last Update Date: 08/11/2020
Certification Date: 08/11/2020
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: 435-843-3600
  • Fax:
Mailing address:
  • Phone: 435-843-3600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code275N00000X
TaxonomyMedicare Defined Swing Bed Hospital Unit
License Number2005-HOSP-14233
License Number StateUT

VIII. Authorized Official

Name: RANDY MICHAEL COOPER
Title or Position: SVP FINANCE OP/AUTHORIZED OFFICIAL
Credential:
Phone: 615-221-3840