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General NPI Number Information
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NPI Number | 1184172249
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Entity Type | Organization
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Legal Business Name | INTERMOUNTAIN
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Dates
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Enumeration Date | 09/19/2016
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Last Update Date | 09/19/2016
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Provider Practice Location Address
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Address Line | 86 W 975 N
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City | HURRICANE
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State | UT
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Zip | 84737-1735
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Country | US
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Telephone | 435-251-6740
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Fax | 435-251-6741
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Provider Business Mailing Address
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Address Line | 86 W 975 N
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City | HURRICANE
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State | UT
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Zip | 84737-1735
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Country | US
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Telephone | 435-251-6740
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Fax | 435-251-6741
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Authorized Official
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Title or Position | FNP
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Name | MELANIE REESE
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Credential | FNP
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Telephone | 435-229-6339
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number | F0916460
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License Number State | UT
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