Provider Demographics
NPI: | 1760429302 |
---|---|
Name: | IHC HEALTH SERVICES INC |
Entity Type: | Organization |
Organization Name: | IHC HEALTH SERVICES INC |
Other - Org Name: | DELTA COMMUNITY HOSPITAL PHYSICIANS |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | CFO |
Authorized Official - Prefix: | MR |
Authorized Official - First Name: | DENIS |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | SMITH |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 801-442-2000 |
Mailing Address - Street 1: | PO BOX 30180 |
Mailing Address - Street 2: | |
Mailing Address - City: | SALT LAKE CITY |
Mailing Address - State: | UT |
Mailing Address - Zip Code: | 84130-0180 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 801-442-8468 |
Mailing Address - Fax: | 801-442-0066 |
Practice Address - Street 1: | 126 WHITE SAGE AVE |
Practice Address - Street 2: | |
Practice Address - City: | DELTA |
Practice Address - State: | UT |
Practice Address - Zip Code: | 84624-8937 |
Practice Address - Country: | US |
Practice Address - Phone: | 435-864-5591 |
Practice Address - Fax: | 435-864-4186 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2006-06-01 |
Last Update Date: | 2023-09-14 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
207P00000X, 207Q00000X, 207R00000X, 207RC0000X, 207W00000X, 2083P0011X, 208800000X, 363A00000X, 363L00000X, 367500000X | ||
UT | 2005HOSP25384 | 261QM1300X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 261QM1300X | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty | Group - Multi-Specialty |
No | 207P00000X | Allopathic & Osteopathic Physicians | Emergency Medicine | Group - Multi-Specialty | |
No | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
No | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
No | 207RC0000X | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | Group - Multi-Specialty |
No | 207W00000X | Allopathic & Osteopathic Physicians | Ophthalmology | Group - Multi-Specialty | |
No | 2083P0011X | Allopathic & Osteopathic Physicians | Preventive Medicine | Undersea and Hyperbaric Medicine | Group - Multi-Specialty |
No | 208800000X | Allopathic & Osteopathic Physicians | Urology | 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 | |
No | 367500000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
UT | 000064770 | Medicare ID - Type Unspecified | |
UT | 000007255 | Medicare ID - Type Unspecified | |
UT | 000006296 | Medicare ID - Type Unspecified | |
UT | 000006369 | Medicare ID - Type Unspecified | |
UT | U000006079 | Medicare PIN |