MEDICARE: BEAVER VALLEY HOSPITAL

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	313M00000X	Nursing Facility/Intermediate Care Facility

General Provider Information

NPI Number	:	1952708182
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEAVER VALLEY HOSPITAL

Provider Business Mailing Address
First Line	:	876 W 700 S
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84104-1404
Country	:	US
Telephone Number	:	801-709-4358
Fax Number	:

Provider Business Practice Location Address
First Line	:	876 W 700 S
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84104-1404
Country	:	US
Telephone Number	:	801-709-4358
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	MR. WALTER ERIC MYERS
Credential	:
Telephone Number	:	801-709-4358

Provider Enumeration Date	:	12/03/2014
Last Update Date	:	11/13/2015

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Directions to “BEAVER VALLEY HOSPITAL ” Practice Location

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