Healthcare Provider Details

I. General information

NPI: 1285435875
Provider Name (Legal Business Name): IH PHYSICIAN SERVICES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2025
Last Update Date: 05/16/2025
Certification Date: 05/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 TECHNOLOGY DR STE 250
CANONSBURG PA
15317-9513
US

IV. Provider business mailing address

PO BOX 4060 ATTN: REGULATORY
MOORESVILLE NC
28117-4060
US

V. Phone/Fax

Practice location:
  • Phone: 704-664-2876
  • Fax: 704-230-0946
Mailing address:
  • Phone: 704-664-2876
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: MARK A FOX
Title or Position: OWNER
Credential:
Phone: 704-574-6442