| NPI | 1659401537 |
|---|---|
| Doing Business As | SOUTHRIDGE CLINIC SURGICAL SPECIALTIES |
| Entity Type | Organization |
| Authorized Contact | LINDA C LECKMAN CEO Intermountain Medical Group 801-442-3974 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: UT 2005200) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: UT 2005200) |
| 207V00000X Obstetrics & Gynecology (Licence: UT 2005200) | |
| Enumeration Date | 2007-03-07 |
| Last Update Date | 2017-01-19 |