MEDICARE: INTERMOUNTAIN HEALTH CARE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	282NC2000X	Children's Hospital	327855-4405	UT

General Provider Information

NPI Number	:	1144408675
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTERMOUNTAIN HEALTH CARE

Provider Business Mailing Address
First Line	:	3159 EAGLE ROCK WAY
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84120-1424
Country	:	US
Telephone Number	:	801-840-0639
Fax Number	:

Provider Business Practice Location Address
First Line	:	3159 EAGLE ROCK WAY
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84120-1424
Country	:	US
Telephone Number	:	801-840-0639
Fax Number	:

Authorized Official
Title or Position	:	NNP
Name	:	MRS. KRISTIN KAY KRISTENSEN
Credential	:	BSN, MSN, APRN
Telephone Number	:	801-840-0639

Provider Enumeration Date	:	02/06/2008
Last Update Date	:	02/06/2008

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Directions to “INTERMOUNTAIN HEALTH CARE ” Practice Location

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