Provider Demographics
NPI:1306094438
Name:UNIVERSITY OF UTAH PAYSON REGIONAL DIALYSIS CENTER
Entity type:Organization
Organization Name:UNIVERSITY OF UTAH PAYSON REGIONAL DIALYSIS CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PROGRAM ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:L
Authorized Official - Last Name:HEMMING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-581-8573
Mailing Address - Street 1:P.O. BOX 27071
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84127-0071
Mailing Address - Country:US
Mailing Address - Phone:801-581-3983
Mailing Address - Fax:
Practice Address - Street 1:15 S 1000 E
Practice Address - Street 2:#50
Practice Address - City:PAYSON
Practice Address - State:UT
Practice Address - Zip Code:84651-5590
Practice Address - Country:US
Practice Address - Phone:801-888-8888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-03
Last Update Date:2014-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT462543Medicare Oscar/Certification