Healthcare Provider Details

I. General information

NPI: 1013058395
Provider Name (Legal Business Name): IHC HEALTH SERVICE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2007
Last Update Date: 07/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 N MAIN ST
EPHRAIM UT
84627-1155
US

IV. Provider business mailing address

PO BOX 27128
SALT LAKE CITY UT
84127-0128
US

V. Phone/Fax

Practice location:
  • Phone: 435-283-4076
  • Fax: 435-283-4078
Mailing address:
  • Phone: 435-283-4076
  • Fax: 435-283-4078

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number1195
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number1195
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number1195
License Number StateUT

VIII. Authorized Official

Name: LINDA C LECKMAN
Title or Position: CEO - INTERMOUNTAIN MEDICAL GROUP
Credential: MD
Phone: 801-442-3974