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	2084P0804X	Child & Adolescent Psychiatry Physician
2	2084P0800X	Psychiatry Physician

General Provider Information

NPI Number	:	1871847434
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IHC HEALTH SERVICES INC

Provider Business Mailing Address
First Line	:	PO BOX 27128
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84127-0128
Country	:	US
Telephone Number	:	801-357-7525
Fax Number	:

Provider Business Practice Location Address
First Line	:	395 W BULLDOG BLVD STE 601
Second Line	:
City	:	PROVO
State	:	UT
Zip	:	84604-3331
Country	:	US
Telephone Number	:	801-357-7525
Fax Number	:

Authorized Official
Title or Position	:	SVP - CHIEF PHY EXECUTIVE
Name	:	DR. MARK BRIESACHER
Credential	:	MD
Telephone Number	:	801-442-3495

Provider Enumeration Date	:	11/05/2012
Last Update Date	:	01/14/2021

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Directions to “IHC HEALTH SERVICES INC ” Practice Location

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