Healthcare Provider Details

I. General information

NPI: 1104956150
Provider Name (Legal Business Name): IHC HEALTH SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 01/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1316 N HIGHWAY 89
FARMINGTON UT
84025-3841
US

IV. Provider business mailing address

PO BOX 27128
SALT LAKE CITY UT
84127-0128
US

V. Phone/Fax

Practice location:
  • Phone: 801-447-3361
  • Fax:
Mailing address:
  • Phone: 801-447-3361
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number008742
License Number StateUT

VIII. Authorized Official

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