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	207Q00000X	Family Medicine Physician	4552012	UT

General Provider Information

NPI Number	:	1922367721
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	:	801-977-0502
Fax Number	:

Provider Business Practice Location Address
First Line	:	855 CALIFORNIA AVE
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84104-1632
Country	:	US
Telephone Number	:	801-977-0502
Fax Number	:

Authorized Official
Title or Position	:	CEO INTERMOUNTAIN MEDICAL GROUP
Name	:	LINDA C LECKMAN
Credential	:	MD
Telephone Number	:	801-442-3974

Provider Enumeration Date	:	05/14/2012
Last Update Date	:	05/14/2012

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Directions to “IHC HEALTH SERVICES INC ” Practice Location

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