NPI: 1487764411
Provider Name: INTERMOUNTAIN EAR,NOSE, AND THROAT SPECIALISTS LLC
Former Legal Business Name: EAR,NOSE AND THROAT CENTER OF SALT LAKE CITY
Classification: Clinic/Center - 261QM2500X
Entity Type: Organization
Specialization: Medical Specialty
CLIA Number: 46D2043484
Address:
22 S 900 E
SALT LAKE CITY, UT
ZIP 84102
Phone: (801) 328-2522
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INTERMOUNTAIN EAR,NOSE, AND THROAT SPECIALISTS LLC is a medical specialty clinic center in Salt Lake City, UT. The provider is an entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to a specific area of medical specialization. Frequently used for Title V related Children's Specialty services or to meet specific public health needs (e.g., infectious diseases or breast and cervical cancer). INTERMOUNTAIN EAR,NOSE, AND THROAT SPECIALISTS LLC NPI is 1487764411. The provider is registered as an organization entity type.
The provider Former Legal Business Name Is Ear,nose And Throat Center Of Salt Lake City.
The provider's business location address is:
22 S 900 E
SALT LAKE CITY, UT
ZIP 84102-307
Phone: (801) 328-2522
Fax: (801) 924-2900
The provider's authorized official is Evon Pefaur .
The authorized official title is Billing Manager and has the following contact phone number (801) 328-2522.
The CLIA number assigned to this NPI record is 46D2043484 - physician office with a certificate type of Certificate of Waiver.
The enumeration date for this NPI number is 8/31/2006 and was last updated on 4/20/2008.