Healthcare Provider Details

I. General information

NPI: 1588055511
Provider Name (Legal Business Name): IHC HEALTH SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2015
Last Update Date: 01/14/2021
Certification Date: 01/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

395 W COUGAR BLVD STE 102
PROVO UT
84604-3334
US

IV. Provider business mailing address

PO BOX 27128
SALT LAKE CITY UT
84127-0128
US

V. Phone/Fax

Practice location:
  • Phone: 801-357-8586
  • Fax:
Mailing address:
  • Phone: 801-442-3631
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number742502015
License Number StateUT

VIII. Authorized Official

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