Organization
INTERMOUNTAIN SPINE AND PAIN CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TRACEY H KARTSONE (ACCOUNTS MANAGER)
(435) 753-1600
Entity
Organization
Contact information
Practice address
286 N GATEWAY DR, PROVIDENCE, UT 84332-9733
(435) 753-1600
(435) 753-9521
Mailing address
274 N MAIN ST, LOGAN, UT 84321-3915
(435) 753-1600
(435) 753-9521
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
0329116-1204
UT
Other
Enumeration date
03/29/2007
Last updated
08/22/2020
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