MEDICARE: IHC HEALTH SERVICES, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	302R00000X	Health Maintenance Organization

General Provider Information

NPI Number	:	1639312812
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IHC HEALTH SERVICES, INC

Provider Business Mailing Address
First Line	:	4646 LAKE PARK BLVD
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84120-8212
Country	:	US
Telephone Number	:	801-442-8468
Fax Number	:	801-442-0066

Provider Business Practice Location Address
First Line	:	36 S STATE ST
Second Line	:	950
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84111-1401
Country	:	US
Telephone Number	:	801-442-1466
Fax Number	:	801-442-0066

Authorized Official
Title or Position	:	MEDICARE ENROLLMENT SPECIALIST
Name	:	MRS. HEATHER PAYNE
Credential	:
Telephone Number	:	801-442-8468

Provider Enumeration Date	:	04/17/2009
Last Update Date	:	04/14/2011

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Directions to “IHC HEALTH SERVICES, INC ” Practice Location

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