| NPI | 1740032002 |
|---|---|
| Doing Business As | INTERMOUNTAIN SURGERY CENTER - RIVERTON |
| Entity Type | Organization |
| Authorized Contact | MIKE CLARK Board Member 314-574-5201 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical |
| Enumeration Date | 2024-04-02 |
| Last Update Date | 2024-04-02 |