| NPI | 1841232352 |
|---|---|
| Doing Business As | INTERMOUNTAIN SOUTH OGDEN |
| Entity Type | Organization |
| Authorized Contact | PAUL T VAN WAGENEN Director Of Operations 801-387-3470 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 103T00000X Psychologist |
| Enumeration Date | 2006-06-11 |
| Last Update Date | 2020-08-22 |