Intermountain Spine and Pain Center

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

0329116-1204 Issued in UT

Legal business name

INTERMOUNTAIN SPINE AND PAIN CENTER

Practice address

286 N Gateway Dr
Providence, UT 84332-9733

Phone

(435) 753-1600

Fax

(435) 753-9521

NPI assigned

Mar 29, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Tracey H Kartsone

Title

Accounts Manager

Phone

(435) 753-1600

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jeanette C Hepburn, APRN

  • Nurse Practitioner
  • Providence, UT
  • NPI 1922246487
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1175126400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1215057955",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "274 N MAIN ST",
            "city": "LOGAN",
            "state": "UT",
            "postal_code": "843213915",
            "telephone_number": "435-753-1600",
            "fax_number": "435-753-9521"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "286 N GATEWAY DR",
            "city": "PROVIDENCE",
            "state": "UT",
            "postal_code": "843329733",
            "telephone_number": "435-753-1600",
            "fax_number": "435-753-9521"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTERMOUNTAIN SPINE AND PAIN CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-29",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "KARTSONE",
        "authorized_official_first_name": "TRACEY",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "ACCOUNTS MANAGER",
        "authorized_official_telephone_number": "435-753-1600"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "UT",
            "license": "0329116-1204",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Daniel J Huff, DPM
• Makara Morgan Humes, RBT
• Kenidee Hyde
• Idaho Pain Center and Anesthesia PC
• Integrity Chiropractic
• Interwest Anesthesia Associates LLC
• James Dennis Mathews, D.O., P.C.
• Travis James, DO
• Jordyn Jay, RBT
• Dylan Wyatt Jensen, RBT

• All providers in Providence, UT
• Ambulatory Surgical Clinic/Center in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.