Healthcare Provider Details

I. General information

NPI: 1912347451
Provider Name (Legal Business Name): INTERMOUNTAIN HEALTH CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2013
Last Update Date: 06/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5770 S 250 E STE 310
MURRAY UT
84107-8110
US

IV. Provider business mailing address

5770 S 250 E STE 310
MURRAY UT
84107-8110
US

V. Phone/Fax

Practice location:
  • Phone: 801-314-4500
  • Fax: 801-314-2909
Mailing address:
  • Phone: 801-314-4500
  • Fax: 801-314-2909

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number195697-3102
License Number StateUT

VIII. Authorized Official

Name: DR. PAUL MINER
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 801-314-4500