Provider Demographics
NPI:1639118417
Name:INTERMOUNTAIN ESD
Entity Type:Organization
Organization Name:INTERMOUNTAIN ESD
Other - Org Name:IMESD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:S
Authorized Official - Last Name:MULVIHILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-966-3101
Mailing Address - Street 1:2001 SW NYE AVE
Mailing Address - Street 2:
Mailing Address - City:PENDLETON
Mailing Address - State:OR
Mailing Address - Zip Code:97801-4416
Mailing Address - Country:US
Mailing Address - Phone:541-276-6616
Mailing Address - Fax:541-276-4252
Practice Address - Street 1:2001 SW NYE AVE
Practice Address - Street 2:
Practice Address - City:PENDLETON
Practice Address - State:OR
Practice Address - Zip Code:97801-4416
Practice Address - Country:US
Practice Address - Phone:541-276-6616
Practice Address - Fax:541-276-4252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-06
Last Update Date:2011-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR008032Medicaid