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	282N00000X	General Acute Care Hospital	4936671-2401	UT

General Provider Information

NPI Number	:	1184966772
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTERMOUNTAIN HEALTH CARE

Provider Business Mailing Address
First Line	:	1410 S MCCLELLAND ST
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84105-2408
Country	:	US
Telephone Number	:	801-884-6848
Fax Number	:

Provider Business Practice Location Address
First Line	:	1410 S MCCLELLAND ST
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84105-2408
Country	:	US
Telephone Number	:	801-884-6848
Fax Number	:

Authorized Official
Title or Position	:	PHYSICAL THERAPIST
Name	:	DR. MORGAN R FRY
Credential	:	DPT
Telephone Number	:	801-507-7000

Provider Enumeration Date	:	03/21/2013
Last Update Date	:	03/21/2013

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