| Organization Name: | BONNEVILLE DIALYSIS CENTER |
| NPI Number: | 1003915513 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | STEVEN L HEMMING (PROGRAM ADMINISTRATOR) |
| Mailing Address: | 5575 S 500 E Ogden |
| State: | UT US |
| Postal Code: | 844056907 |
| Phone Number: | 8014790351 |
| Fax Number: | 8014761766 |
| NPI Enumeration Date: | 09/21/2006 |
| NPI Last Update Date: | 09/11/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QE0700X |
| License Number: | 2004-ESRD-389 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | UT |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | End-Stage Renal Disease (ESRD) Treatment |
| Taxonomy Definition: | |