# INTERMOUNTAIN PEDIATRIC CLINIC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

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

## Provider details

- **NPI number:** 1740499433
- **Authorized official:** MS. SUSAN HARRIS (OFFICE MANAGER)
- **Authorized official phone:** (801) 355-4316

## Contact information

- **Practice address:** 508 E SOUTH TEMPLE, SUITE 310, SALT LAKE CITY, UT 84102-1013
- **Practice address phone:** (801) 355-4316
- **Practice address fax:** (801) 355-6267
- **Mailing address:** 508 E SOUTH TEMPLE, SUITE 310, SALT LAKE CITY, UT 84102-1013
- **Mailing address phone:** (801) 355-4316
- **Mailing address fax:** (801) 355-6267

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2080H0002X | Pediatric Hospice and Palliative Medicine Physician | 19920633 | UT | Yes |

## Other

- **Enumeration date:** 05/21/2007
- **Last updated:** 08/22/2020