# INTERMOUNTAIN SPINE AND PAIN CENTER

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1215057955
- **Authorized official:** TRACEY H KARTSONE (ACCOUNTS MANAGER)
- **Authorized official phone:** (435) 753-1600

## Contact information

- **Practice address:** 286 N GATEWAY DR, PROVIDENCE, UT 84332-9733
- **Practice address phone:** (435) 753-1600
- **Practice address fax:** (435) 753-9521
- **Mailing address:** 274 N MAIN ST, LOGAN, UT 84321-3915
- **Mailing address phone:** (435) 753-1600
- **Mailing address fax:** (435) 753-9521

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QA1903X | Ambulatory Surgical Clinic/Center | 0329116-1204 | UT | Yes |

## Other

- **Enumeration date:** 03/29/2007
- **Last updated:** 08/22/2020