Healthcare Provider Details

I. General information

NPI: 1104953652
Provider Name (Legal Business Name): IHC HEALTH SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 08/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

652 S MEDICAL CENTER DR SUITE 400
ST GEORGE UT
84790-7017
US

IV. Provider business mailing address

PO BOX 27128
SALT LAKE CITY UT
84127-0128
US

V. Phone/Fax

Practice location:
  • Phone: 435-251-2650
  • Fax:
Mailing address:
  • Phone: 435-251-2650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number00003888
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number00003888
License Number StateUT

VIII. Authorized Official

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