Provider Demographics
NPI:1134429384
Name:INTERMOUNTAIN MEDICAL MONITORING LLC
Entity type:Organization
Organization Name:INTERMOUNTAIN MEDICAL MONITORING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER/BOARD MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:DARIN
Authorized Official - Middle Name:S
Authorized Official - Last Name:STETTLER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:801-755-4509
Mailing Address - Street 1:1306 DEERCREST
Mailing Address - Street 2:
Mailing Address - City:FRUIT HEIGHTS
Mailing Address - State:UT
Mailing Address - Zip Code:84037
Mailing Address - Country:US
Mailing Address - Phone:801-755-4509
Mailing Address - Fax:801-593-9848
Practice Address - Street 1:1306 DEER CREST
Practice Address - Street 2:
Practice Address - City:FRUIT HEIGHTS
Practice Address - State:UT
Practice Address - Zip Code:84037
Practice Address - Country:US
Practice Address - Phone:801-755-4509
Practice Address - Fax:801-593-9848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-21
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6049595-1204207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty