Healthcare Provider Details

I. General information

NPI: 1467819060
Provider Name (Legal Business Name): IHC HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2016
Last Update Date: 01/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5169 S COTTONWOOD ST BUILDING 2, SUITE 510
MURRAY UT
84107-6767
US

IV. Provider business mailing address

5169 S COTTONWOOD ST BUILDING 2, SUITE 510
MURRAY UT
84107-6767
US

V. Phone/Fax

Practice location:
  • Phone: 801-507-3513
  • Fax:
Mailing address:
  • Phone: 801-507-3513
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number9619004-1206
License Number StateUT

VIII. Authorized Official

Name: JENNIFER NELSON
Title or Position: OFFICE MANAGER
Credential:
Phone: 801-507-3513