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1400 Foothill Dr #101 Salt Lake City UT 84108-2327 | |
| (801) 582-7767 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Family Medicine |
| Location | 1400 Foothill Dr, Salt Lake City, Utah |
| Authorized Official Name and Position | Linda C Leckman (CEO INTERMOUNTAIN MEDICAL GROUP) |
| Authorized Official Contact | 8014423974 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 27128 Salt Lake City UT 84127-0128 Ph: (801) 582-7767 | 1400 Foothill Dr #101 Salt Lake City UT 84108-2327 Ph: (801) 582-7767 |
| NPI Number | 1437285731 |
|---|---|
| Provider Enumeration Date | 02/23/2007 |
| Last Update Date | 01/21/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1437285731 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 19960603 (Utah) | Primary |
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