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NPI Code Detail

MEDICARE: INTERMOUNTAIN SPINE PARTNERS

MEDICARE: INTERMOUNTAIN SPINE PARTNERS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208100000XPhysical Medicine & Rehabilitation Physician
2363A00000XPhysician Assistant
3207XS0117XOrthopaedic Surgery of the Spine Physician

General Provider Information

NPI Number : 1821458878
Entity Type Code : Organization
Provider Name (Legal Business Name) : INTERMOUNTAIN SPINE PARTNERS
Provider Business Mailing Address
First Line : 5770 SOUTH 250 EAST
Second Line : SUITE 135
City : SALT LAKE CITY
State : UT
Zip : 84107-8241
Country : US
Telephone Number : 801-314-2225
Fax Number : 801-314-2345
Provider Business Practice Location Address
First Line : 5770 SOUTH 250 EAST
Second Line : SUITE 135
City : SALT LAKE CITY
State : UT
Zip : 84107-8241
Country : US
Telephone Number : 801-314-2225
Fax Number : 801-314-2345
Authorized Official
Title or Position : DIRECTOR
Name : REED EUGENE FOGG
Credential : M.D.
Telephone Number : 801-314-2225
Provider Enumeration Date : 03/03/2016
Last Update Date : 03/03/2016

Similar Medicare Providers

1881663870 — DR. REED FOGG M.D.
Practice Location Address:
5770 SOUTH 250 EAST , SUITE 135
SALT LAKE CITY, UT
84107-8241
Practice Phone: 801-314-2225
Practice Fax: 801-314-2345
1982673505 — DR. ROBERT BERRY M.D.
Practice Location Address:
5770 SOUTH 250 EAST , SUITE 135
SALT LAKE CITY, UT
84107-8241
Practice Phone: 801-314-2225
Practice Fax: 801-314-2345
1164481008 — TERRY SAWCHUK M.D.
Practice Location Address:
5770 SOUTH 250 EAST , SUITE 135
SALT LAKE CITY, UT
84107-8241
Practice Phone: 801-314-2225
Practice Fax: 801-314-2345
1427018761 — DR. JUNIUS CLAWSON M.D.
Practice Location Address:
5770 SOUTH 250 EAST , SUITE 135
SALT LAKE CITY, UT
84107-8241
Practice Phone: 801-314-2225
Practice Fax: 801-314-2345
1922068212 — MR. JAMES BRADLEY DAVIS P.A.-C.
Practice Location Address:
5770 SOUTH 250 EAST , SUITE 135
SALT LAKE CITY, UT
84107-8241
Practice Phone: 801-314-2225
Practice Fax: 801-314-2345
1639371149 — JUSTIN B HOHL MD
Practice Location Address:
5770 SOUTH 250 EAST , SUITE 135
SALT LAKE CITY, UT
84107-8241
Practice Phone: 801-314-2225
Practice Fax: 801-314-2345

Directions to “INTERMOUNTAIN SPINE PARTNERS ” Practice Location

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