Provider Demographics
NPI:1609110816
Name:IHC HEALTH SERVICES, INC.
Entity Type:Organization
Organization Name:IHC HEALTH SERVICES, INC.
Other - Org Name:SEVIER VALLEY MEDICAL CENTER PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:BISHOFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-893-0232
Mailing Address - Street 1:1000 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RICHFIELD
Mailing Address - State:UT
Mailing Address - Zip Code:84701-1857
Mailing Address - Country:US
Mailing Address - Phone:435-893-0232
Mailing Address - Fax:435-893-0540
Practice Address - Street 1:1000 N MAIN ST
Practice Address - Street 2:
Practice Address - City:RICHFIELD
Practice Address - State:UT
Practice Address - Zip Code:84701-1857
Practice Address - Country:US
Practice Address - Phone:435-893-0232
Practice Address - Fax:435-893-0540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-15
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6381230-17043336I0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336I0012XSuppliersPharmacyInstitutional Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT870269232324Medicaid
4612392OtherNCPDP PROVIDER IDENTIFICATION NUMBER