Anthem Dialysis LLC

Primary specialty

Renal Dialysis TechnicianTaxonomy code 2472R0900X

Legal business name

ANTHEM DIALYSIS LLC

Practice address

1213 Flint Meadow Dr Ste 1B
Kaysville, UT 84037-6833

Phone

(385) 420-7500

Fax

(385) 420-7501

NPI assigned

Jul 19, 2018

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mark Flinders

Title

Owner/Ceo

Phone

(801) 917-9000

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1531958400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1647216000000",
    "number": "1609353994",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "942 FRANCIS CIR",
            "city": "KAYSVILLE",
            "state": "UT",
            "postal_code": "840379661",
            "telephone_number": "801-917-9000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1213 FLINT MEADOW DR STE 1B",
            "city": "KAYSVILLE",
            "state": "UT",
            "postal_code": "840376833",
            "telephone_number": "385-420-7500",
            "fax_number": "385-420-7501"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANTHEM DIALYSIS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-07-19",
        "last_updated": "2022-03-14",
        "certification_date": "2022-03-14",
        "status": "A",
        "authorized_official_last_name": "FLINDERS",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "OWNER/CEO",
        "authorized_official_telephone_number": "801-917-9000"
    },
    "taxonomies": [
        {
            "code": "2472R0900X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Technician, Other, Renal Dialysis",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1609353994",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.