Provider Demographics
NPI:1063748028
Name:INTERMOUNTAIN HEALTHCARE
Entity type:Organization
Organization Name:INTERMOUNTAIN HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NEONATAL NURSE PRACTITIONER
Authorized Official - Prefix:MS
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:K
Authorized Official - Last Name:BARNEY
Authorized Official - Suffix:
Authorized Official - Credentials:NNP
Authorized Official - Phone:801-518-4717
Mailing Address - Street 1:4401 HARRISON BLVD
Mailing Address - Street 2:NEWBORN INTENSIVE CARE UNIT
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403-3195
Mailing Address - Country:US
Mailing Address - Phone:801-387-4326
Mailing Address - Fax:801-387-4306
Practice Address - Street 1:4401 HARRISON BLVD
Practice Address - Street 2:NEWBORN INTENSIVE CARE UNIT
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-3195
Practice Address - Country:US
Practice Address - Phone:801-387-4326
Practice Address - Fax:801-387-4306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-27
Last Update Date:2009-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT293473-4405282NC2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC2000XHospitalsGeneral Acute Care HospitalChildren
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT=========2Medicaid