NPIMap

Organization Active NPI

Intermountain Ear,Nose, and Throat Specialists LLC

  • Medical Specialty Clinic/Center
  • Salt Lake City, UT
National Provider Identifier
1487764411
Registry record updated Apr 20, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Specialty Clinic/CenterTaxonomy code 261QM2500X
Legal business name
INTERMOUNTAIN EAR,NOSE, AND THROAT SPECIALISTS LLC
Practice address
22 S 900 E
Salt Lake City, UT 84102-1307
Phone
(801) 328-2522
Fax
(801) 924-2900
NPI assigned
Aug 31, 2006
Last updated
Apr 20, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 20, 2008

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

Authorized official

Name
Evon Pefaur, CPC
Title
Billing Manager
Phone
(801) 328-2522

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Specialty Clinic/Center 261QM2500X Primary

Addresses

Primary practice location

22 S 900 E
Salt Lake City, UT 84102-1307

Mailing address

22 S 900 E
Salt Lake City, UT 84102-1307
Phone (801) 328-2522

Other names 1

  • Ear,Nose and Throat Center of Salt Lake City Former legal business name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040206000267 UT Part B Supplier - Clinic/Group Practice 8022901610 Receives reassigned benefits from 30 practitioners
Practice locations: Roosevelt, UT; West Jordan, UT; Tooele, UT; Salt Lake City, UT; Millcreek, UT; Lehi, UT; Heber City, UT; Draper, UT…

National Provider Directory

National Provider Directory

Locations

13825 S Redwood Rd
Ste 250
Bluffdale, UT 84065

1716 N Highway 40
Ste 100
Heber City, UT 84032

1588 E 3300 S
Millcreek, UT 84106
Phone (801) 495-4800

1777 Sun Peak Dr
Ste 150
Park City, UT 84098
Phone (435) 645-0800

1820 Sidewinder Dr
Ste 110
Park City, UT 84060
Phone (435) 649-4106

7138 S Highland Dr
#213A
Salt Lake Cty, UT 84121

9690 S 1300 E
Ste 200
Sandy, UT 84094
Phone (801) 501-4300

453 N Main St
Tooele, UT 84074
Phone (435) 249-7292

4052 W Pioneer Pkwy
#210
West Valley City, UT 84120
Phone (801) 966-8534

Practitioners & affiliated clinicians

Practitioners 39

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 39

NPI Registry JSON

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208649600000",
    "number": "1487764411",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22 S 900 E",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841021307",
            "telephone_number": "801-328-2522",
            "fax_number": "801-924-2900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22 S 900 E",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841021307",
            "telephone_number": "801-328-2522",
            "fax_number": "801-924-2900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTERMOUNTAIN EAR,NOSE, AND THROAT SPECIALISTS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-31",
        "last_updated": "2008-04-20",
        "status": "A",
        "authorized_official_last_name": "PEFAUR",
        "authorized_official_first_name": "EVON",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "801-328-2522",
        "authorized_official_credential": "CPC"
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ear,Nose and Throat Center of Salt Lake City",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Salt Lake City, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.