NPIMap

Organization Active NPI

Intermountain Medical Group Grand Junction, LLC

Doing business as SMMG Satellite - Medical Oncology Moab

  • Hematology & Oncology Physician
  • Moab, UT
National Provider Identifier
1649883547
Registry record updated Jun 28, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hematology & Oncology PhysicianTaxonomy code 207RH0003X
Legal business name
INTERMOUNTAIN MEDICAL GROUP GRAND JUNCTION, LLC
Doing business as
SMMG Satellite - Medical Oncology Moab
Practice address
450 Williams Way
Moab, UT 84532-2185
Phone
(435) 719-3500
Fax
(435) 719-3529
NPI assigned
Aug 28, 2020
Organization subpart
Yes
Parent organization
INTERMOUNTAIN FRONT RANGE, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 28, 2024

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

Authorized official

Name
Jon McDaniel
Title
VP Finance Medical Group
Phone
(303) 272-0231

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Hematology & Oncology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RH0003X Primary

Addresses

Primary practice location

450 Williams Way
Moab, UT 84532-2185

Mailing address

450 Williams Way
Moab, UT 84532-2185
Phone (435) 719-3500

Other names 1

  • SMMG Satellite - Medical Oncology Moab Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Intermountain Medical Group44 organizations share this tax ID, including this one
Part of
Intermountain Front Range I

Other organizations with this tax ID 43

Organizations that report the same tax identification number in the National Provider Directory.

View all 43

NPI Registry JSON

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

{
    "created_epoch": "1598572800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1719532800000",
    "number": "1649883547",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "450 WILLIAMS WAY",
            "city": "MOAB",
            "state": "UT",
            "postal_code": "845322185",
            "telephone_number": "435-719-3500",
            "fax_number": "435-719-3529"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "450 WILLIAMS WAY",
            "city": "MOAB",
            "state": "UT",
            "postal_code": "845322185",
            "telephone_number": "435-719-3500",
            "fax_number": "435-719-3529"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTERMOUNTAIN MEDICAL GROUP GRAND JUNCTION, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "INTERMOUNTAIN FRONT RANGE, INC.",
        "enumeration_date": "2020-08-28",
        "last_updated": "2024-06-28",
        "certification_date": "2024-06-28",
        "status": "A",
        "authorized_official_last_name": "MCDANIEL",
        "authorized_official_first_name": "JON",
        "authorized_official_title_or_position": "VP FINANCE MEDICAL GROUP",
        "authorized_official_telephone_number": "303-272-0231"
    },
    "taxonomies": [
        {
            "code": "207RH0003X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SMMG Satellite - Medical Oncology Moab",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "SMMG Satellite - Medical Oncology Moab",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Moab, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2024; 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.