OrganizationActive
Intermountain Pediatric Clinic
NPI 1740499433 · Pediatric Hospice and Palliative Medicine Physician · Salt Lake City, UT
Provider details
- NPI number
- 1740499433
- Entity type
- Organization
- Primary specialty
- Pediatric Hospice and Palliative Medicine PhysicianAllopathic & Osteopathic Physicians
- Authorized official
- Susan Harris, Office Manager
- License
- 19920633 (UT)
Practice location
508 E South Temple
Suite 310
Salt Lake City, UT 84102-1013
Phone: (801) 355-4316
Fax: (801) 355-6267
Mailing address
508 E South Temple
Salt Lake City, UT 84102-1013
Registry dates
- Enumerated
- 2007-05-21
- Last updated
- 2020-08-22
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.