Healthcare Provider Details

I. General information

NPI: 1942332465
Provider Name (Legal Business Name): INTERMOUNTAIN HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2007
Last Update Date: 06/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4401 S HARRISON BLVD MCKAY-DEE
OGDEN UT
84403
US

IV. Provider business mailing address

2621 W 4050 S
ROY UT
84067-8776
US

V. Phone/Fax

Practice location:
  • Phone: 801-387-7025
  • Fax: 801-387-5511
Mailing address:
  • Phone: 801-387-7028
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number3589293501
License Number StateUT

VIII. Authorized Official

Name: MR. ROBERT JOHN HUNTER
Title or Position: CRISIS WORKER
Credential: LCSW
Phone: 801-387-7025