Healthcare Provider Details

I. General information

NPI: 1750417853
Provider Name (Legal Business Name): IHC HEALTH SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2007
Last Update Date: 01/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5169 COTTONWOOD ST STE 440
SALT LAKE CITY UT
84107-6774
US

IV. Provider business mailing address

PO BOX 27128
SALT LAKE CITY UT
84127-0128
US

V. Phone/Fax

Practice location:
  • Phone: 801-507-3915
  • Fax:
Mailing address:
  • Phone: 801-408-3555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number20012306
License Number StateUT

VIII. Authorized Official

Name: DR. LINDA C LECKMAN
Title or Position: CEO INTERMOUNTAIN MEDICAL GROUP
Credential: MD
Phone: 801-442-3974