Provider Demographics
NPI:1588747638
Name:WEST VALLEY DIALYSIS CENTER
Entity type:Organization
Organization Name:WEST VALLEY DIALYSIS CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:L
Authorized Official - Last Name:HEMMING
Authorized Official - Suffix:
Authorized Official - Credentials:MBA,BSN
Authorized Official - Phone:801-581-8573
Mailing Address - Street 1:85 N. MEDICAL DR., EAST RM. 201
Mailing Address - Street 2:C/O DIALYSIS PROGRAM - UNIVERSITY OF UTAH
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84112-5350
Mailing Address - Country:US
Mailing Address - Phone:801-581-8573
Mailing Address - Fax:
Practice Address - Street 1:3854 W 5400 S
Practice Address - Street 2:
Practice Address - City:TAYLORSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84129-3549
Practice Address - Country:US
Practice Address - Phone:801-581-8573
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2016-08-26
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
UT462533Medicare Oscar/Certification