Healthcare Provider Details
I. General information
NPI: 1326641374
Provider Name (Legal Business Name): IHC HEALTH SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 11/20/2020
Last Update Date: 11/20/2020
Certification Date: 11/20/2020
Deactivation Date:
Reactivation Date:
III. Provider practice location address
5171 S COTTONWOOD ST STE 350
MURRAY UT
84107-5733
US
IV. Provider business mailing address
PO BOX 27128
SALT LAKE CITY UT
84127-0128
US
V. Phone/Fax
- Phone: 801-507-7751
- Fax:
- Phone: 801-507-7751
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 207RI0200X |
| Taxonomy | Infectious Disease Physician |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name: DR.
MARK
BRIESACHER
Title or Position: SVP-CHIEF PHY EXECUTIVE
Credential: MD
Phone: 801-442-3495