Healthcare Provider Details

I. General information

NPI: 1013674530
Provider Name (Legal Business Name): IHC HEALTH SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2021
Last Update Date: 11/18/2021
Certification Date: 11/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4421 HARRISON BLVD STE A12
OGDEN UT
84403-3174
US

IV. Provider business mailing address

PO BOX 27128
SALT LAKE CITY UT
84127-0128
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 TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARK BRIESACHER
Title or Position: SVP-CHIEF PHYS EXECUTIVE
Credential: MD
Phone: 801-442-3495