Provider Demographics
NPI:1184172249
Name:INTERMOUNTAIN
Entity type:Organization
Organization Name:INTERMOUNTAIN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FNP
Authorized Official - Prefix:
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:REESE
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:435-229-6339
Mailing Address - Street 1:86 W 975 N
Mailing Address - Street 2:
Mailing Address - City:HURRICANE
Mailing Address - State:UT
Mailing Address - Zip Code:84737-1735
Mailing Address - Country:US
Mailing Address - Phone:435-251-6740
Mailing Address - Fax:435-251-6741
Practice Address - Street 1:86 W 975 N
Practice Address - Street 2:
Practice Address - City:HURRICANE
Practice Address - State:UT
Practice Address - Zip Code:84737-1735
Practice Address - Country:US
Practice Address - Phone:435-251-6740
Practice Address - Fax:435-251-6741
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-19
Last Update Date:2016-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UTF0916460282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital