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General NPI Number Information
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NPI Number | 1134429384
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Entity Type | Organization
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Legal Business Name | INTERMOUNTAIN MEDICAL MONITORING LLC
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Dates
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Enumeration Date | 10/21/2010
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Last Update Date | 11/10/2011
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Provider Practice Location Address
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Address Line | 1306 DEER CREST
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City | FRUIT HEIGHTS
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State | UT
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Zip | 84037
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Country | US
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Telephone | 801-755-4509
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Fax | 801-593-9848
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Provider Business Mailing Address
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Address Line | 1306 DEERCREST
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City | FRUIT HEIGHTS
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State | UT
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Zip | 84037
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Country | US
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Telephone | 801-755-4509
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Fax | 801-593-9848
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Authorized Official
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Title or Position | OWNER/MANAGER/BOARD MEMBER
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Name | MR. DARIN S STETTLER
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Credential | D.O.
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Telephone | 801-755-4509
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | 6049595-1204
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License Number State | UT
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