MEDICARE: INTERMOUNTAIN ORTHOPEDIC CARE, LLC

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	332BC3200X	Customized Equipment (DME)

General Provider Information

NPI Number	:	1699798827
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTERMOUNTAIN ORTHOPEDIC CARE, LLC

Provider Business Mailing Address
First Line	:	471 E 1000 S STE E
Second Line	:
City	:	PLEASANT GROVE
State	:	UT
Zip	:	84062-3694
Country	:	US
Telephone Number	:	855-407-1227
Fax Number	:	855-228-4222

Provider Business Practice Location Address
First Line	:	471 E 1000 S STE E
Second Line	:
City	:	PLEASANT GROVE
State	:	UT
Zip	:	84062-3694
Country	:	US
Telephone Number	:	855-407-1227
Fax Number	:	855-228-4222

Authorized Official
Title or Position	:	OWNER
Name	:	QUINN BEARDALL
Credential	:
Telephone Number	:	855-407-1227

Provider Enumeration Date	:	07/26/2006
Last Update Date	:	07/08/2022

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