MEDICARE: IHC HEALTH SERVICES INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	5032008	UT

General Provider Information

NPI Number	:	1609029495
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IHC HEALTH SERVICES INC

Provider Business Mailing Address
First Line	:	PO BOX 27128
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84127-0128
Country	:	US
Telephone Number	:	801-273-2777
Fax Number	:

Provider Business Practice Location Address
First Line	:	3934 S 2300 E
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84124-1830
Country	:	US
Telephone Number	:	801-273-6777
Fax Number	:

Authorized Official
Title or Position	:	CEO INTERMOUNTAIN MEDICAL GROUP
Name	:	DR. LINDA C LECKMAN
Credential	:	MD
Telephone Number	:	801-442-3974

Provider Enumeration Date	:	10/24/2008
Last Update Date	:	10/24/2008

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