Healthcare Provider Details

I. General information

NPI: 1154842607
Provider Name (Legal Business Name): IHC HEALTH SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2017
Last Update Date: 07/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 W LAYTON PARKWAY
LAYTON UT
84041
US

IV. Provider business mailing address

PO BOX 27128
LAYTON UT
84120-0128
US

V. Phone/Fax

Practice location:
  • Phone: 801-442-1853
  • Fax:
Mailing address:
  • Phone: 801-442-1853
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MARK BRIESACHER
Title or Position: CHIEF PHYS EXEC AND PRES MED GROUP
Credential: MD
Phone: 801-442-3495