Basic Information
| Provider Information | |||||||||
| NPI: | 1184669699 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | INPATIENT CONSULTANTS OF UTAH, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2000 S COLORADO BLVD | ||||||||
| Address2: | ANNEX BLDG, SUITE 420 | ||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802227900 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7205241550 | ||||||||
| FaxNumber: | 7205241551 | ||||||||
| Practice Location | |||||||||
| Address1: | 2000 S COLORADO BLVD | ||||||||
| Address2: | ANNEX BLDG, SUITE 420 | ||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802227900 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7205241550 | ||||||||
| FaxNumber: | 7205241551 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/18/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | STULL | ||||||||
| AuthorizedOfficialFirstName: | RICHARD | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 7205241550 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | X | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | 207R00000X | X | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.