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General NPI Number Information
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NPI Number | 1760732507
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Entity Type | Organization
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Legal Business Name | INTERMOUNTAIN HEALTHCARE
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Dates
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Enumeration Date | 09/19/2012
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Last Update Date | 09/19/2012
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Provider Practice Location Address
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Address Line | 5770 S 1500 W BLDG C
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City | TAYLORSVILLE
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State | UT
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Zip | 84123-5216
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Country | US
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Telephone | 801-313-7800
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Fax |
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Provider Business Mailing Address
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Address Line | 5770 S 1500 W BLDG C
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City | TAYLORSVILLE
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State | UT
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Zip | 84123
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PSYCHIATRIC PROGRAM ADMIN DIRECTOR
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Name | TAMMER ATTALLAH
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Credential |
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Telephone | 801-313-7703
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 273R00000X
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Taxonomy Name | Psychiatric Hospital Unit
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License Number | 4968440-2501
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License Number State | UT
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