Healthcare Provider Details

I. General information

NPI: 1396036695
Provider Name (Legal Business Name): JORDAN VALLEY MEDICAL CENTER LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2011
Last Update Date: 04/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3460 PIONEER PKWY
WEST VALLEY CITY UT
84120-2049
US

IV. Provider business mailing address

3460 S PIONEER PKWY ATTN: BILLING
WEST VALLEY CITY UT
84120-2049
US

V. Phone/Fax

Practice location:
  • Phone: 801-964-3100
  • Fax: 801-964-3247
Mailing address:
  • Phone: 801-964-3100
  • Fax: 801-964-3247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273R00000X
TaxonomyPsychiatric Hospital Unit
License Number
License Number State

VIII. Authorized Official

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