| Intermountain South Ogden | |
|
975 Chambers St South Ogden UT 84403-4591 | |
| (801) 387-6200 | |
| (801) 387-6234 |
| Full Name | Intermountain South Ogden |
|---|---|
| Speciality | Family Medicine |
| Location | 975 Chambers St, South Ogden, Utah |
| Authorized Official Name and Position | Paul T Van Wagenen (DIRECTOR OF OPERATIONS) |
| Authorized Official Contact | 8013873470 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Intermountain South Ogden 975 Chambers St South Ogden UT 84403-4591 Ph: (801) 387-6200 | Intermountain South Ogden 975 Chambers St South Ogden UT 84403-4591 Ph: (801) 387-6200 |
| NPI Number | 1841232352 |
|---|---|
| Provider Enumeration Date | 06/11/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1841232352 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | (* (Not Available)) | Primary |
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
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