Provider Demographics
| NPI: | 1306888722 |
|---|---|
| Name: | IHC HEALTH SERVICES INC |
| Entity type: | Organization |
| Organization Name: | IHC HEALTH SERVICES INC |
| Other - Org Name: | <UNAVAIL> |
| Other - Org Type: | |
| Authorized Official - Title/Position: | CEO / VICE PRESIDENT |
| Authorized Official - Prefix: | DR |
| Authorized Official - First Name: | LINDA |
| Authorized Official - Middle Name: | C |
| Authorized Official - Last Name: | LECKMAN |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | MD |
| Authorized Official - Phone: | 801-442-3974 |
| Mailing Address - Street 1: | PO BOX 27128 |
| Mailing Address - Street 2: | |
| Mailing Address - City: | SALT LAKE CITY |
| Mailing Address - State: | UT |
| Mailing Address - Zip Code: | 84127-0128 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 801-442-2997 |
| Mailing Address - Fax: | 801-442-2867 |
| Practice Address - Street 1: | 36 S STATE ST |
| Practice Address - Street 2: | MEDICAL GROUP - FINANCE DEPARTMENT |
| Practice Address - City: | SALT LAKE CITY |
| Practice Address - State: | UT |
| Practice Address - Zip Code: | 84111-1401 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 801-442-2997 |
| Practice Address - Fax: | 801-442-2867 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2006-06-11 |
| Last Update Date: | 2010-06-08 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
| No | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
| No | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics | Group - Multi-Specialty | |
| No | 207V00000X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Group - Multi-Specialty | |
| No | 207N00000X | Allopathic & Osteopathic Physicians | Dermatology | Group - Multi-Specialty | |
| No | 207X00000X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Group - Multi-Specialty | |
| No | 207Y00000X | Allopathic & Osteopathic Physicians | Otolaryngology | Group - Multi-Specialty | |
| No | 208100000X | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Group - Multi-Specialty | |
| No | 208600000X | Allopathic & Osteopathic Physicians | Surgery | Group - Multi-Specialty | |
| No | 208G00000X | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) | Group - Multi-Specialty | |
| No | 208800000X | Allopathic & Osteopathic Physicians | Urology | Group - Multi-Specialty | |
| No | 2085R0001X | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology | Group - Multi-Specialty |
| No | 208200000X | Allopathic & Osteopathic Physicians | Plastic Surgery | Group - Multi-Specialty | |
| No | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Group - Multi-Specialty | |
| No | 363L00000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| UT | 000055456 | Medicare PIN |
