Verification Lookup Portal
Providers for IMH
Provider Last Name
Last name is required.
Provider First Name
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Provider NPI
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NPI value is invalid. Must be a ten-digit number.
Required Information
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Requester Name
Name is required.
Requester Title
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Requester Organization
Organization is required.
Requester Address
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Requester City, State, Zip
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Requester Phone
Phone is required.
Requester Fax
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Requester Email
Email is required.
I agree and acknowledge that I possess a signed release and immunity statement signed by the practitioner for which I am obtaining hospital verification information. Such signed release and immunity holds harmless and indemnifies Intermountain Health and individuals providing information pursuant to this request, its medical staff, board of directors and each of their respective members and designees, the administration of such Intermountain Health and its directors, officers, employees, representatives and agents, and each of them from any and all claims, demands or actions with respect to all acts, including without limitation, communications, reports, recommendations, or disclosures performed or made in connection with the request for the release of information pertaining to the practitioner's hospital affiliation with Intermountain Health.
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Provider Search
Please Enter the Following Information:
Provider Last Name
Requester Name
Requester Organization
Requester Phone
Requester Email