Provider Demographics
NPI: | 1508904947 |
---|---|
Name: | IHC HEALTH SERVICES, INC |
Entity Type: | Organization |
Organization Name: | IHC HEALTH SERVICES, INC |
Other - Org Name: | MEMORIAL CLINIC |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | VICE PRESIDENT CHIEF EX OFFICER |
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: | 801-442-3499 |
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: | 801-464-7500 |
Mailing Address - Fax: | 801-464-7876 |
Practice Address - Street 1: | 2000 S 900 E |
Practice Address - Street 2: | |
Practice Address - City: | SALT LAKE CITY |
Practice Address - State: | UT |
Practice Address - Zip Code: | 84105-3208 |
Practice Address - Country: | US |
Practice Address - Phone: | 801-464-7500 |
Practice Address - Fax: | 801-464-7876 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2007-02-01 |
Last Update Date: | 2008-07-31 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
UT | 19960601 | 101YM0800X, 183500000X, 207K00000X, 207N00000X, 207R00000X, 207RG0100X, 207RP1001X, 207T00000X, 207V00000X, 207X00000X, 207Y00000X, 208000000X, 246RM2200X, 2471C3402X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
No | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health | Group - Multi-Specialty |
No | 183500000X | Pharmacy Service Providers | Pharmacist | Group - Multi-Specialty | |
No | 207K00000X | Allopathic & Osteopathic Physicians | Allergy & Immunology | Group - Multi-Specialty | |
No | 207N00000X | Allopathic & Osteopathic Physicians | Dermatology | Group - Multi-Specialty | |
No | 207RG0100X | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology | Group - Multi-Specialty |
No | 207RP1001X | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease | Group - Multi-Specialty |
No | 207T00000X | Allopathic & Osteopathic Physicians | Neurological Surgery | Group - Multi-Specialty | |
No | 207V00000X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Group - Multi-Specialty | |
No | 207X00000X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Group - Multi-Specialty | |
No | 207Y00000X | Allopathic & Osteopathic Physicians | Otolaryngology | Group - Multi-Specialty | |
No | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics | Group - Multi-Specialty | |
No | 246RM2200X | Technologists, Technicians & Other Technical Service Providers | Technician, Pathology | Medical Laboratory | Group - Multi-Specialty |
No | 2471C3402X | Technologists, Technicians & Other Technical Service Providers | Radiologic Technologist | Radiography | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
000055456 | Medicare PIN |