WEST BOUNTIFUL DIALYSIS Full NPI Record 1629032610
Clinic/Center - End-Stage Renal Disease (ESRD) Treatment in West Bountiful, UT

Complete NPI Dataset

The following table represents the complete NPI 1629032610 dataset for West Bountiful Dialysis in 724 W 500 S STE 300 WEST BOUNTIFUL, UT 84087. The data table includes a list of all field names, values and definitions of the complete NPI record. The NPI dataset is available for download in CSV format using the "Download NPI" button below at the end of the table.

Name Value Definition
NPI1629032610The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
Entity Type Code2Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Employer Identification Number EINUNAVAILThe Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
Provider Organization Name Legal Business NameTOTAL RENAL CARE INCThe name of the organization provider. If the provider is an organization, this is the legal business name.
Provider Other Organization NameWEST BOUNTIFUL DIALYSISOther name by which the organization provider is or has been known.
Provider Other Organization Name Type Code3Code identifying the type of other name. Codes are: 1 = former name; 2 = professional name; 3 = doing business as (d/b/ a) name; 4 = former legal business name; 5 = other.
Provider First Line Business Mailing Address5200 VIRGINIA WAYThe first line mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider first line location address’’.
Provider Second Line Business Mailing AddressL&C DEPTThe second line mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider second line location address’’.
Provider Business Mailing Address City NameBRENTWOODThe city name in the mailing address of the provider being identified.
Provider Business Mailing Address State NameTNThe State or Province name in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address State name’’.
Provider Business Mailing Address Postal Code370277569The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as ‘‘Provider location address postal code’’.
Provider Business Mailing Address Country Code If outside U S USThe country code in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address country code’’.
Provider Business Mailing Address Telephone Number6153416814The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address telephone number’’.


Provider Business Mailing Address Fax Number8002938405The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address fax number’’.
Provider First Line Business Practice Location Address724 W 500 SThe first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Second Line Business Practice Location AddressSTE 300The second line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City NameWEST BOUNTIFULThe city name in the location address of the provider being identified.
Provider Business Practice Location Address State NameUTThe State code in the location of the provider being identified.
Provider Business Practice Location Address Postal Code84087The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Country Code If outside U S USThe country code in the location address of the provider being identified.
Provider Business Practice Location Address Telephone Number8012969091The telephone number associated with the location address of the provider being identified.
Provider Business Practice Location Address Fax Number8012969094The fax number associated with the location address of the provider being identified.
Provider Enumeration Date4/14/2006The date the provider was assigned a unique identifier (assigned an NPI).
Last Update Date7/15/2020The date that a record was last updated or changed.
Authorized Official Last NameWINSTELThe last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
Authorized Official First NameJOHNThe first name of the authorized official.
Authorized Official Title or PositionCHIEF ACCOUNTING OFFICERThe title or position of the authorized official.
Authorized Official Telephone Number2537334501The 10-position telephone number of the authorized official.
Healthcare Provider Taxonomy Code 1261QE0700XCode designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
Provider License Number 12017-ESRD-928The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
Provider License Number State Code 1UTThe code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
Healthcare Provider Primary Taxonomy Switch 1Y
Other Provider Identifier 1870570546015Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 105Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 1UT
Is Organization SubpartN
NPI Certification Date7/15/2020