Provider Demographics
NPI:1922731827
Name:INTERMOUNTAIN REGENERATIVE MEDICINE
Entity Type:Organization
Organization Name:INTERMOUNTAIN REGENERATIVE MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BARRS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-439-1512
Mailing Address - Street 1:1075 S UTAH AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83402-3320
Mailing Address - Country:US
Mailing Address - Phone:208-218-8622
Mailing Address - Fax:
Practice Address - Street 1:1075 S UTAH AVE STE 200
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83402-3320
Practice Address - Country:US
Practice Address - Phone:208-218-8622
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-07
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty