Healthcare Provider Details

I. General information

NPI: 1700897923
Provider Name (Legal Business Name): INTERMOUNTAIN HEART CENTER, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 08/21/2023
Certification Date: 08/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5292 COLLEGE DR SUITE 201
MURRAY UT
84123-2672
US

IV. Provider business mailing address

5292 COLLEGE DR SUITE 201
MURRAY UT
84123-2672
US

V. Phone/Fax

Practice location:
  • Phone: 801-281-4278
  • Fax: 801-281-5960
Mailing address:
  • Phone: 801-281-4278
  • Fax: 801-281-5960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number3605311205
License Number StateUT

VIII. Authorized Official

Name: STEPHEN L MILLER
Title or Position: PRESIDENT
Credential: MD
Phone: 801-281-4278