MEDICARE: DIALYSIS PROGRAM PHYSICIANS UNIVERSITY OF UTAH

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	174400000X	Specialist

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CI6697	OTHER	UT	RR MEDICARE

General Provider Information

NPI Number	:	1689770356
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIALYSIS PROGRAM PHYSICIANS UNIVERSITY OF UTAH

Provider Business Mailing Address
First Line	:	PO BOX 841462
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90084-1462
Country	:	US
Telephone Number	:	801-581-8578
Fax Number	:	801-581-4750

Provider Business Practice Location Address
First Line	:	515 E 100 S STE 350
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84102-3766
Country	:	US
Telephone Number	:	801-581-8578
Fax Number	:	801-581-4750

Authorized Official
Title or Position	:	PROGRAM ADMINISTRATOR
Name	:	MR. STEVEN L HEMMING
Credential	:
Telephone Number	:	801-581-8573

Provider Enumeration Date	:	09/16/2006
Last Update Date	:	04/08/2022

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