Organization
INTERMOUNTAIN PEDIATRIC CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. SUSAN HARRIS (OFFICE MANAGER)
(801) 355-4316
Entity
Organization
Contact information
Practice address
508 E SOUTH TEMPLE, SUITE 310, SALT LAKE CITY, UT 84102-1013
(801) 355-4316
(801) 355-6267
Mailing address
508 E SOUTH TEMPLE, SUITE 310, SALT LAKE CITY, UT 84102-1013
(801) 355-4316
(801) 355-6267
Taxonomy
Speciality
Code
Description
License number
State
2080H0002X
Pediatric Hospice and Palliative Medicine Physician
Primary
19920633
UT
Other
Enumeration date
05/21/2007
Last updated
08/22/2020
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