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General NPI Number Information
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NPI Number | 1134274947
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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 | 01/24/2007
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Last Update Date | 02/25/2016
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Provider Practice Location Address
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Address Line | 196 WEST 2000 NORTH SUITE 112
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City | TOOELE
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State | UT
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Zip | 84074-2736
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Country | US
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Telephone | 801-408-1430
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Fax |
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Provider Business Mailing Address
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Address Line | 4646 LAKE PARK BLVD
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City | SALT LAKE CITY
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State | UT
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Zip | 84120-8212
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CHIEF FINANCIAL OFFICER
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Name | DAVE LARSEN
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Credential |
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Telephone | 801-408-1883
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QE0700X
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Taxonomy Name | End-Stage Renal Disease (ESRD) Treatment Clinic/Center
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License Number | 2005-ESRD-0608
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License Number State | UT
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