SOUTH MOUNTAIN DIALYSIS, LLC (NPI# 1033159488) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1033159488 |
| Entity Type | Organization |
| Organization Name | SOUTH MOUNTAIN DIALYSIS, LLC |
| Practice Address |
10969 River Front Pkwy #100 South Jordan UT 84095-3538 |
| Mailing Address |
7650 Se 27th St Suite 200 Mercer Island WA 98040-3060 |
| Practice Telephone | 8012539696 |
| Practice Fax Number | 8012533303 |
| Mailing Telephone | 2062365001 |
| Mailing Fax Number | 2062365002 |
| Enumeration Date | 2006-06-07 |
| Last Update Date | 2011-07-25 |
| Authorized Official Name | MR. RYAN B PARDO (VICE PRESIDENT) |
| Authorized Official Telephone | 2062365001 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QE0700X |
Clinic/Center Specialization: End-Stage Renal Disease (ESRD) Treatment |
Ambulatory Health Care Facilities |
| Street Address |
10969 RIVER FRONT PKWY #100 |
| City | SOUTH JORDAN |
| State | UT |
| Zip Code | 84095-3538 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033745393 | Beverly Laraine Williams | Social Worker | 11260 S River Heights Drive, South Jordan, UT 84095 | 2020-03-19 |
| 1265902902 | Sarah Richele Kelley | Specialist/Technologist | 10236 Alder Grovey Way, South Jordan, UT 84095 | 2018-11-26 |
| 1326528837 | Kristi Couse | Massage Therapist | 10679 S 2200 W Apt 2, South Jordan, UT 84095 | 2018-08-15 |
| 1821516063 | River Crossing Dental Professional Corporation | Clinic/Center | 12427 South 4000 West, Suite #200, Riverton, UT 84095 | 2017-09-08 |
| 1245755719 | Staci Stout | Dental Hygienist | 3113 W Swiss Pass Cir, South Jordan, UT 84095 | 2017-08-07 |
| 1437698750 | Ryan Sears | Dentist | 10894 So. River Front Parkway, South Jordan, UT 84095 | 2017-02-20 |
| 1366989931 | Ultimate Sports Regenerative Medicine | Chiropractor | 1098 W. South Jordan Pkwy, Suite 101, South Jordan, UT 84095 | 2017-01-20 |
| 1306393889 | Tal Quirl | Optometrist | 3571 W. 10400 S., South Jordan, UT 84095 | 2016-09-01 |
| 1023562667 | Sevon Taroian | Social Worker | 11260 River Heights Drive, South Jordan, UT 84095 | 2016-08-11 |
| 1952762932 | Megan Buckley | Developmental Therapist | 881 Baxter Drive, Ste 100, South Jordan, UT 84095 | 2016-03-17 |
| Find all providers in zip 84095 | ||||
| Taxonomy Code | 261QE0700X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | End-Stage Renal Disease (ESRD) Treatment |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710587571 | Bmh Kidney Care LLC | Clinic/Center | 802 S 200 W Ste B, Blanding, UT 84511-3910 | 2020-10-29 |
| 1053956391 | Hegan Dialysis, LLC | Clinic/Center | 490 S State St, Orem, UT 84058-6302 | 2019-11-11 |
| 1811554124 | Pomme Dialysis, LLC | Clinic/Center | 1250 W Sandalwood Dr, Lehi, UT 84043-4615 | 2019-05-22 |
| 1992223556 | Wakonda Dialysis LLC | Clinic/Center | 555 W State Road 164 Ste 101, Salem, UT 84653-5732 | 2017-09-05 |
| 1831627223 | Fresenius Medical Care Provo, LLC | Clinic/Center | 135 South Orem Blvd, Ste 101, Orem, UT 84058-3006 | 2017-05-30 |
| 1407394463 | Fresenius Medical Care Pleasant View, LLC | Clinic/Center | 1735 West 2700 North, Farr West, UT 84404-1208 | 2017-02-09 |
| 1356897961 | Fresenius Medical Care Utah, LLC | Clinic/Center | 4101 W Pioneer Pkwy, Suite 101, West Valley City, UT 84120-2050 | 2016-09-01 |
| 1770951030 | Liberty Dialysis-weber County, LLC | Clinic/Center | 475 East 40th St, Suite 110, South Ogden, UT 84403-1852 | 2015-09-03 |
| 1558746727 | Fresenius Medical Care Riverton, LLC | Clinic/Center | 12523 South Meadow Creek Drive, Riverton, UT 84065-7259 | 2015-07-29 |
| 1093199135 | Fresenius Medical Care Cedar City, LLC | Clinic/Center | 1320 North Main Street, Cedar City, UT 84721 | 2015-07-18 |
| Find all providers with the same taxonomy | ||||
| City | SOUTH JORDAN |
| Zip Code | 84095 |
Please comment or provide details below to improve the information on SOUTH MOUNTAIN DIALYSIS, LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.