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General NPI Number Information
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NPI Number | 1710384367
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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 | 11/25/2014
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Last Update Date | 11/29/2018
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Provider Practice Location Address
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Address Line | 3845 W 4700 S
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City | TAYLORSVILLE
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State | UT
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Zip | 84129-3454
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Country | US
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Telephone | 801-840-8444
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Fax | 801-840-2127
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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 | 801-840-8444
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Fax |
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Authorized Official
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Title or Position | SVP-CHIEF EXEC PHYS/PRES-IMGROUP
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Name | MARK BRIESACHER
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Credential | MD
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Telephone | 801-442-3495
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 742462014
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 207K00000X
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Taxonomy Name | Allergy & Immunology Physician
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License Number | 742462014
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License Number State | UT
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