| Organization Name: | BLUE MOUNTAIN HOSPITAL DIALYSIS |
| NPI Number: | 1033538731 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JEREMY LYMAN (CEO) |
| Mailing Address: | 802 S 200 W Suite A Blanding |
| State: | UT US |
| Postal Code: | 845113910 |
| Phone Number: | 4356783993 |
| Fax Number: | |
| NPI Enumeration Date: | 04/09/2014 |
| NPI Last Update Date: | 04/09/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 282NC0060X |
| License Number: | 2012-ESRD-90350 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | UT |
| Taxonomy Type: | Hospitals |
| Taxonomy Classification: | General Acute Care Hospital |
| Taxonomy Specialization: | Critical Access |
| Taxonomy Definition: | |