Provider Demographics
| NPI: | 1629260880 |
|---|---|
| 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: | 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 |
