Provider Demographics
NPI:1699798827
Name:INTERMOUNTAIN ORTHOPEDIC CARE, LLC
Entity type:Organization
Organization Name:INTERMOUNTAIN ORTHOPEDIC CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:QUINN
Authorized Official - Middle Name:
Authorized Official - Last Name:BEARDALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:855-407-1227
Mailing Address - Street 1:471 E 1000 S STE E
Mailing Address - Street 2:
Mailing Address - City:PLEASANT GROVE
Mailing Address - State:UT
Mailing Address - Zip Code:84062-3694
Mailing Address - Country:US
Mailing Address - Phone:855-407-1227
Mailing Address - Fax:855-228-4222
Practice Address - Street 1:471 E 1000 S STE E
Practice Address - Street 2:
Practice Address - City:PLEASANT GROVE
Practice Address - State:UT
Practice Address - Zip Code:84062-3694
Practice Address - Country:US
Practice Address - Phone:855-407-1227
Practice Address - Fax:855-228-4222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT=========009Medicaid
UT1233310002Medicare ID - Type Unspecified