Healthcare Provider Details

I. General information

NPI: 1144490160
Provider Name (Legal Business Name): JORDAN VALLEY MEDICAL CENTER LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2008
Last Update Date: 04/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3580 W 9000 S
WEST JORDAN UT
84088-8812
US

IV. Provider business mailing address

3580 W 9000 S ATTN: BILLING
WEST JORDAN UT
84088-8812
US

V. Phone/Fax

Practice location:
  • Phone: 801-561-8888
  • Fax: 801-569-8723
Mailing address:
  • Phone: 801-561-8888
  • Fax: 801-569-8723

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273Y00000X
TaxonomyRehabilitation Hospital Unit
License Number2008-HOSP-810
License Number StateUT

VIII. Authorized Official

Name: STEVEN M ANDERSON
Title or Position: HOSPITAL CEO
Credential:
Phone: 801-561-8888