Organization Name: | SOUTH MOUNTAIN DIALYSIS, LLC |
NPI Number: | 1033159488 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | RYAN B PARDO (VICE PRESIDENT) |
Mailing Address: | 10969 River Front Pkwy #100 South Jordan |
State: | UT US |
Postal Code: | 840953538 |
Phone Number: | 8012539696 |
Fax Number: | 8012533303 |
NPI Enumeration Date: | 06/07/2006 |
NPI Last Update Date: | 07/25/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QE0700X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | End-Stage Renal Disease (ESRD) Treatment |
Taxonomy Definition: |