Provider Demographics
NPI:1467463489
Name:INTERMOUNTAIN STROKE CENTER, INC.
Entity Type:Organization
Organization Name:INTERMOUNTAIN STROKE CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:N
Authorized Official - Last Name:FUTRELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-263-0611
Mailing Address - Street 1:5292 COLLEGE DR
Mailing Address - Street 2:SUITE 204
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84123-2672
Mailing Address - Country:US
Mailing Address - Phone:801-263-0611
Mailing Address - Fax:801-263-9141
Practice Address - Street 1:5292 COLLEGE DR
Practice Address - Street 2:SUITE 204
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84123-2672
Practice Address - Country:US
Practice Address - Phone:801-263-0611
Practice Address - Fax:801-263-9141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084V0102XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyVascular NeurologyGroup - Single Specialty