MEDICARE: JORDAN VALLEY MEDICAL CENTER LP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	282N00000X	General Acute Care Hospital	2005HOSP811	UT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	95900	OTHER		PEHP
2	103002113105	OTHER		IHC SELECT HEALTH ER
3	103002113104	OTHER		IHC SELECT HEALTH
4	310486	OTHER	UT	ALTIUS

General Provider Information

NPI Number	:	1366440620
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JORDAN VALLEY MEDICAL CENTER LP

Provider Business Mailing Address
First Line	:	3460 S PIONEER PKWY
Second Line	:	ATTN: BILLING
City	:	WEST VALLEY CITY
State	:	UT
Zip	:	84120-2049
Country	:	US
Telephone Number	:	801-964-3100
Fax Number	:	801-964-3247

Provider Business Practice Location Address
First Line	:	3460 PIONEER PKWY
Second Line	:
City	:	WEST VALLEY CITY
State	:	UT
Zip	:	84120-2049
Country	:	US
Telephone Number	:	801-964-3122
Fax Number	:	801-964-3112

Authorized Official
Title or Position	:	HOSPITAL CEO
Name	:	STEVEN M ANDERSON
Credential	:
Telephone Number	:	801-964-3800

Provider Enumeration Date	:	07/11/2005
Last Update Date	:	04/04/2018

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