Provider Demographics
NPI:1831467778
Name:INTERMOUNTAIN ANESTHESIA SERVICES, PC
Entity Type:Organization
Organization Name:INTERMOUNTAIN ANESTHESIA SERVICES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SLOAN
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-405-4300
Mailing Address - Street 1:5930 ROYAL LN STE E-264
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-3849
Mailing Address - Country:US
Mailing Address - Phone:888-559-2666
Mailing Address - Fax:
Practice Address - Street 1:5406 W 11000 N STE 103-236
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:UT
Practice Address - Zip Code:84003-8942
Practice Address - Country:US
Practice Address - Phone:888-559-2666
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-07
Last Update Date:2013-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7977575-1205207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty