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General NPI Number Information
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NPI Number | 1790089530
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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 | 01/10/2011
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Last Update Date | 01/10/2011
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Provider Practice Location Address
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Address Line | 4401 HARRISON BLVD
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City | OGDEN
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State | UT
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Zip | 84403-3195
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Country | US
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Telephone | 801-387-7023
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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 | 801-387-7023
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Fax |
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Authorized Official
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Title or Position | CEO INTERMOUNTAIN MEDICAL GROUP
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Name | DR. LINDA C LECKMAN
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Credential | MD
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Telephone | 801-442-3974
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP3000X
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Taxonomy Name | Pediatric Anesthesiology Physician
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License Number | 3832011
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License Number State | UT
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