Healthcare Provider Details

I. General information

NPI: 1528339769
Provider Name (Legal Business Name): IHC HEALTH SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2012
Last Update Date: 01/07/2021
Certification Date: 01/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

544 S 400 E
ST GEORGE UT
84770-3705
US

IV. Provider business mailing address

PO BOX 27128
SALT LAKE CITY UT
84127-0128
US

V. Phone/Fax

Practice location:
  • Phone: 435-688-4700
  • Fax:
Mailing address:
  • Phone: 435-688-4700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2422012
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2422012
License Number StateUT
# 3
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number2422012
License Number StateUT

VIII. Authorized Official

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