=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881913788
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | IHC HEALTH SERVICES INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/18/2010
-----------------------------------------------------
Last Update Date | 05/18/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1550 E 3400 N
-----------------------------------------------------
City | LEHI
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84043-9692
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-767-4000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 27128
-----------------------------------------------------
City | SALT LAKE CITY
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84127-0128
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 801-767-4000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO/VP INTERMOUNTAIN MEDICAL GROUP
-----------------------------------------------------
Name | DR. LINDA C LECKMAN
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 801-442-3974
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 9412010
-----------------------------------------------------
License Number State | UT
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2083X0100X
-----------------------------------------------------
Taxonomy Name | Occupational Medicine Physician
-----------------------------------------------------
License Number | 9412010
-----------------------------------------------------
License Number State | UT
-----------------------------------------------------