Provider Demographics
| NPI: | 1083624738 |
|---|---|
| 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: | FINANCE AVP-PEDIATRICS |
| Authorized Official - Prefix: | MR |
| Authorized Official - First Name: | SIDNEY |
| Authorized Official - Middle Name: | |
| Authorized Official - Last Name: | NORTON |
| 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: | |
| Mailing Address - Fax: | |
| Practice Address - Street 1: | 81 N MARIO CAPECCHI DR |
| Practice Address - Street 2: | |
| Practice Address - City: | SALT LAKE CITY |
| Practice Address - State: | UT |
| Practice Address - Zip Code: | 84113-1125 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 801-662-1000 |
| Practice Address - Fax: | |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2006-08-08 |
| Last Update Date: | 2025-07-02 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Licenses
| State | License ID | Taxonomies |
|---|---|---|
| 207WX0110X, 207YP0228X, 208000000X, 2080N0001X, 2080P0202X, 2080P0206X, 2080P0210X, 2080P0216X, 2084P0804X, 2085P0229X, 363A00000X, 363L00000X | ||
| UT | HOSP-439 | 261QD0000X, 261QM0801X |
| UT | 2006-HOSP-439 | 261QM1300X |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 261QM1300X | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty | Group - Multi-Specialty |
| No | 207WX0110X | Allopathic & Osteopathic Physicians | Ophthalmology | Pediatric Ophthalmology and Strabismus Specialist | Group - Multi-Specialty |
| No | 207YP0228X | Allopathic & Osteopathic Physicians | Otolaryngology | Pediatric Otolaryngology | Group - Multi-Specialty |
| No | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics | Group - Multi-Specialty | |
| No | 2080N0001X | Allopathic & Osteopathic Physicians | Pediatrics | Neonatal-Perinatal Medicine | Group - Multi-Specialty |
| No | 2080P0202X | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Cardiology | 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 | 2080P0216X | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Rheumatology | Group - Multi-Specialty |
| No | 2084P0804X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Child & Adolescent Psychiatry | Group - Multi-Specialty |
| No | 2085P0229X | Allopathic & Osteopathic Physicians | Radiology | Pediatric Radiology | Group - Multi-Specialty |
| No | 261QD0000X | Ambulatory Health Care Facilities | Clinic/Center | Dental | |
| No | 261QM0801X | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) | |
| 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 | U000006079 | Medicare PIN |