Provider Demographics
NPI:1447601299
Name:INJURY TREATMENT CENTER OF AMERICA MURRAY INC
Entity Type:Organization
Organization Name:INJURY TREATMENT CENTER OF AMERICA MURRAY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:ORMOND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-856-6368
Mailing Address - Street 1:279 EAST 5900 SOUTH
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107
Mailing Address - Country:US
Mailing Address - Phone:801-904-3930
Mailing Address - Fax:
Practice Address - Street 1:279 EAST 5900 SOUTH
Practice Address - Street 2:SUITE 102
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107
Practice Address - Country:US
Practice Address - Phone:801-904-3930
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-23
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center