1639312812 NPI number — IHC HEALTH SERVICES, INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639312812 NPI number — IHC HEALTH SERVICES, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
IHC HEALTH SERVICES, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1639312812
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/14/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4646 LAKE PARK BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SALT LAKE CITY
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84120-8212
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
801-442-8468
Provider Business Mailing Address Fax Number:
801-442-0066

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
36 S STATE ST
Provider Second Line Business Practice Location Address:
950
Provider Business Practice Location Address City Name:
SALT LAKE CITY
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84111-1401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-442-1466
Provider Business Practice Location Address Fax Number:
801-442-0066
Provider Enumeration Date:
04/17/2009

Additional Information

Authorized Official

Authorized Official Last Name:
PAYNE
Authorized Official First Name:
HEATHER
Authorized Official Middle Name:
Authorized Official Title or Position:
MEDICARE ENROLLMENT SPECIALIST
Authorized Official Telephone Number:
801-442-8468

Provider Taxonomy Codes

  • Taxonomy code: 302R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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