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General NPI Number Information
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NPI Number | 1073177648
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Entity Type | Organization
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Legal Business Name | IHC HEALTH SERVICES INC
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Dates
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Enumeration Date | 04/29/2019
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Last Update Date | 04/29/2019
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Provider Practice Location Address
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Address Line | 3723 W 12600 S STE 430
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City | RIVERTON
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State | UT
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Zip | 84065-7310
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Country | US
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Telephone | 801-285-4200
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 27128
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City | SALT LAKE CITY
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State | UT
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Zip | 84127-0128
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Country | US
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Telephone | 801-285-4200
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Fax |
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Authorized Official
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Title or Position | INTMN MEDICAL GROUP PRES/CMO CBC
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Name | SETH GLICKMAN
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Credential | MD
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Telephone | 801-442-2905
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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