Provider Demographics
NPI:1124090659
Name:TOOELE HOSPITAL CORPORATION
Entity type:Organization
Organization Name:TOOELE HOSPITAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SVP FINANCE OP/AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-221-3840
Mailing Address - Street 1:2055 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:TOOELE
Mailing Address - State:UT
Mailing Address - Zip Code:84074-9819
Mailing Address - Country:US
Mailing Address - Phone:435-843-3600
Mailing Address - Fax:
Practice Address - Street 1:2055 N MAIN ST
Practice Address - Street 2:
Practice Address - City:TOOELE
Practice Address - State:UT
Practice Address - Zip Code:84074-9819
Practice Address - Country:US
Practice Address - Phone:435-843-3600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-07
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2005-HOSP-14233282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV001188976Medicaid
010593OtherIHC
NV001288976Medicaid
25323OtherPEHP
103001059101OtherIHC
WY120000300Medicaid
56384OtherLABORS
36724OtherDMBA
CAXHSP43651Medicaid
CAXHSP33651Medicaid
103001059101OtherIHC
CAXHSP43651Medicaid
010593OtherIHC