Provider Demographics
NPI:1700897923
Name:INTERMOUNTAIN HEART CENTER, PC
Entity Type:Organization
Organization Name:INTERMOUNTAIN HEART CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:L
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-281-4278
Mailing Address - Street 1:5292 COLLEGE DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84123-2672
Mailing Address - Country:US
Mailing Address - Phone:801-281-4278
Mailing Address - Fax:801-281-5960
Practice Address - Street 1:5292 COLLEGE DR
Practice Address - Street 2:SUITE 201
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84123-2672
Practice Address - Country:US
Practice Address - Phone:801-281-4278
Practice Address - Fax:801-281-5960
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-11
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT3605311205207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT005791001Medicare PIN
UT000057910Medicare ID - Type UnspecifiedMEDICARE GROUP
UTDD8305Medicare ID - Type UnspecifiedRAILROAD MEDICARE GROUP