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General NPI Number Information
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NPI Number | 1417111394
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Entity Type | Organization
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Legal Business Name | PROMISE HOSPITAL OF SALT LAKE INC
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Dates
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Enumeration Date | 07/10/2008
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Last Update Date | 04/19/2016
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Provider Practice Location Address
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Address Line | 8 TH AVE AND C ST
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City | SALT LAKE CITY
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State | UT
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Zip | 84143-0001
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Country | US
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Telephone | 801-408-7103
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Fax | 801-408-7113
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Provider Business Mailing Address
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Address Line | 8 TH AVE & C ST 4TH FLOOR
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City | SALT LAKE CITY
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State | UT
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Zip | 84143-0001
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Country | US
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Telephone | 801-408-7103
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | WAYNE KINSEY
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Credential | MSN
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Telephone | 801-407-7110
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336I0012X
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Taxonomy Name | Institutional Pharmacy
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License Number | 9187437-1704
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License Number State | UT
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