| NPI | 1083768071 |
|---|---|
| Doing Business As | INTERMOUNTAIN MEDICAL CENTER DIALYSIS SERVICES |
| Entity Type | Organization |
| Authorized Contact | DAVE LARSEN Chief Financial Officer 801-408-1883 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QE0700X Clinic/Center, End-Stage Renal Disease (ESRD) Treatment (Licence: 2005-ESRD-225) |
| Enumeration Date | 2007-01-23 |
| Last Update Date | 2016-02-25 |