Organization
MOUNTAINSTAR INTENSIVIST SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WILLIAM TEDRICK JOHNSON (VICE PRESIDENT)
(615) 372-3375
Entity
Organization
Contact information
Practice address
750 W 800 N, OREM, UT 84057-3660
(801) 714-6387
(801) 714-6596
Mailing address
2000 HEALTH PARK DR, BRENTWOOD, TN 37027-4692
(615) 373-7406
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
Primary
—
—
Other
Enumeration date
11/15/2011
Last updated
08/29/2023
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