=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649400573
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | IHC HEALTH SERVICES INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/27/2009
-----------------------------------------------------
Last Update Date | 01/29/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 154 E MYRTLE AVE STE 103
-----------------------------------------------------
City | MURRAY
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84107-4850
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-507-9100
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11520 S REDWOOD RD
-----------------------------------------------------
City | SOUTH JORDAN
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84095-7805
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 385-887-6000
-----------------------------------------------------
Fax | 801-442-0603
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VP-HOMECARE HOSPICE PALLIATIVE CARE
-----------------------------------------------------
Name | MARK PROVAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 801-442-2000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | UT
-----------------------------------------------------