Provider Demographics
NPI:1528066875
Name:BEAVER VALLEY HOSPITAL
Entity type:Organization
Organization Name:BEAVER VALLEY HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:VAL
Authorized Official - Last Name:DAVIDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:438-438-7100
Mailing Address - Street 1:PO BOX 1670
Mailing Address - Street 2:1109 N 100 W
Mailing Address - City:BEAVER
Mailing Address - State:UT
Mailing Address - Zip Code:84713-1670
Mailing Address - Country:US
Mailing Address - Phone:435-438-7100
Mailing Address - Fax:435-438-7166
Practice Address - Street 1:1109 N 100TH W
Practice Address - Street 2:
Practice Address - City:BEAVER
Practice Address - State:UT
Practice Address - Zip Code:84713-1670
Practice Address - Country:US
Practice Address - Phone:435-438-7100
Practice Address - Fax:435-438-7166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-11
Last Update Date:2017-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT2006-HOSP-167275N00000X
UT2004-HOSP-167282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No275N00000XHospital UnitsMedicare Defined Swing Bed Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000006972OtherPART B LEGACY OR PTAN #
UT000006972OtherPART B LEGACY OR PTAN #
UT460035Medicare Oscar/Certification
UT46U035Medicare Oscar/Certification
UT006344004Medicare Oscar/Certification