Provider Demographics
NPI:1558871590
Name:INTERVENTIONAL MEDICAL CENTER
Entity Type:Organization
Organization Name:INTERVENTIONAL MEDICAL CENTER
Other - Org Name:INTERVENTIONAL MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIE
Authorized Official - Middle Name:N
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-679-3488
Mailing Address - Street 1:32 W WINCHESTER ST STE 100
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-5609
Mailing Address - Country:US
Mailing Address - Phone:801-998-8256
Mailing Address - Fax:801-849-0340
Practice Address - Street 1:1972 W 5400 S
Practice Address - Street 2:
Practice Address - City:TAYLORSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84129-1459
Practice Address - Country:US
Practice Address - Phone:801-998-8256
Practice Address - Fax:801-849-0340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-04
Last Update Date:2017-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer SpecialistGroup - Single Specialty