Provider Demographics
NPI:1144408675
Name:INTERMOUNTAIN HEALTH CARE
Entity Type:Organization
Organization Name:INTERMOUNTAIN HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NNP
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:KRISTENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:BSN, MSN, APRN
Authorized Official - Phone:801-840-0639
Mailing Address - Street 1:3159 EAGLE ROCK WAY
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84120-1424
Mailing Address - Country:US
Mailing Address - Phone:801-840-0639
Mailing Address - Fax:
Practice Address - Street 1:3159 EAGLE ROCK WAY
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84120-1424
Practice Address - Country:US
Practice Address - Phone:801-840-0639
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-06
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT327855-4405282NC2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC2000XHospitalsGeneral Acute Care HospitalChildren