MEDICARE: INTERMOUNTAIN MEDICAL HOLDINGS NEVADA INC

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	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1528822194
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTERMOUNTAIN MEDICAL HOLDINGS NEVADA INC

Provider Business Mailing Address
First Line	:	4003 BOULDER HIGHWAY
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121
Country	:	US
Telephone Number	:	702-968-3265
Fax Number	:

Provider Business Practice Location Address
First Line	:	4003 BOULDER HIGHWAY
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121
Country	:	US
Telephone Number	:	702-968-3265
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MICHELL CLOWARD
Credential	:
Telephone Number	:	435-668-4929

Provider Enumeration Date	:	02/13/2024
Last Update Date	:	02/13/2024

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