Provider Demographics
NPI: | 1629260880 |
---|---|
Name: | IHC HEALTH SERVICES INC |
Entity Type: | Organization |
Organization Name: | IHC HEALTH SERVICES INC |
Other - Org Name: | IMED PHYSICIANS BILLING |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | CHIEF CLINICAL OFFICER |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | JP |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | VALIN |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MD |
Authorized Official - Phone: | 801-442-2000 |
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: | 801-442-1400 |
Mailing Address - Fax: | 801-442-0641 |
Practice Address - Street 1: | 5121 COTTONWOOD ST |
Practice Address - Street 2: | |
Practice Address - City: | MURRAY |
Practice Address - State: | UT |
Practice Address - Zip Code: | 84107-5701 |
Practice Address - Country: | US |
Practice Address - Phone: | 801-442-1400 |
Practice Address - Fax: | 801-442-0641 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2007-08-13 |
Last Update Date: | 2023-09-15 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 261QM1300X | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty | Group - Multi-Specialty |
No | 204F00000X | Allopathic & Osteopathic Physicians | Transplant Surgery | Group - Multi-Specialty | |
No | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
No | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
No | 207RG0100X | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology | Group - Multi-Specialty |
No | 207RN0300X | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology | Group - Multi-Specialty |
No | 207RT0003X | Allopathic & Osteopathic Physicians | Internal Medicine | Transplant Hepatology | Group - Multi-Specialty |
No | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics | Group - Multi-Specialty | |
No | 2080P0206X | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Gastroenterology | Group - Multi-Specialty |
No | 2080P0210X | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Nephrology | Group - Multi-Specialty |
No | 2080T0004X | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Transplant Hepatology | Group - Multi-Specialty |
No | 208600000X | Allopathic & Osteopathic Physicians | Surgery | Group - Multi-Specialty | |
No | 2086S0120X | Allopathic & Osteopathic Physicians | Surgery | Pediatric 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 | 000069006 | Medicare PIN |