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Contact Information

INTERMOUNTAIN PEDIATRIC CLINIC
508 E SOUTH TEMPLE
SUITE 310
SALT LAKE CITY, UT84102-1013
 Phone: 801-355-4316
 Fax: 801-355-6267
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Hospice and Palliative Medicine

2080H0002X 37 Physician/Pediatric Medicine
Indicates primary specialty

NPI Profile & details for INTERMOUNTAIN PEDIATRIC CLINIC

NPI # 1740499433
LBN Legal business name INTERMOUNTAIN PEDIATRIC CLINIC
Authorized official SUSAN HARRIS - (OFFICE MANAGER)
Entity Organization
Organization subpart 1 No
Enumeration date 05/21/2007
Last updated 08/22/2020 - About 6 years ago
Identifiers
UT License # 19920633
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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