Provider Demographics
NPI:1760246342
Name:INTERMOUNTAIN MEDICAL HOLDING NEVADA, INC.
Entity Type:Organization
Organization Name:INTERMOUNTAIN MEDICAL HOLDING NEVADA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:
Authorized Official - Last Name:CLOWARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-668-4929
Mailing Address - Street 1:2580C TEDDY DRIVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89102
Mailing Address - Country:US
Mailing Address - Phone:702-968-3270
Mailing Address - Fax:702-949-6202
Practice Address - Street 1:2580C TEDDY DRIVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102
Practice Address - Country:US
Practice Address - Phone:702-968-3270
Practice Address - Fax:702-949-6202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-13
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care