NPIMap

Organization Active NPI

Ihc Health Services Inc

Doing business as Utah Valley Rock Canyon Pediatric Specialists

  • Pediatric Gastroenterology Physician
  • Provo, UT
National Provider Identifier
1184935231
Registry record updated May 8, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Gastroenterology PhysicianTaxonomy code 2080P0206X
License
8432010 Issued in UT
Legal business name
IHC HEALTH SERVICES INC
Doing business as
Utah Valley Rock Canyon Pediatric Specialists
Practice address
395 W Cougar Blvd Ste 702
Provo, UT 84604-3333
Phone
(801) 357-1700
NPI assigned
Jun 23, 2010
Last updated
May 8, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 8, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Mark Briesacher, M.D.
Title
SVP-Chief Physician Exec Pres Img
Phone
(801) 442-3495

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Cardiology Physician 2080P0202X 8432010 UT
Pediatric Gastroenterology Physician 2080P0206X 8432010 UT Primary

Addresses

Primary practice location

395 W Cougar Blvd Ste 702
Provo, UT 84604-3333

Mailing address

PO Box 27128
Salt Lake City, UT 84127-0128
Phone (801) 357-1700

Other names 1

  • Utah Valley Rock Canyon Pediatric Specialists Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080610000303 UT Part B Supplier - Clinic/Group Practice 1850209420 Receives reassigned benefits from 4,146 practitioners
This NPI is an additional NPI on the enrollment

National Provider Directory

National Provider Directory
Tax ID family
Robert E Fowles MD482 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Locations

550 E 1400 N
Ste S
Logan, UT 84341
Phone (435) 716-1860

395 W Cougar Blvd
Ste 702
Provo, UT 84604
Phone (801) 357-1700

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1277251200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1651968000000",
    "number": "1184935231",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 27128",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841270128",
            "telephone_number": "801-357-1700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "395 W COUGAR BLVD STE 702",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "846043333",
            "telephone_number": "801-357-1700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IHC HEALTH SERVICES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-06-23",
        "last_updated": "2022-05-08",
        "certification_date": "2022-05-08",
        "status": "A",
        "authorized_official_last_name": "BRIESACHER",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "SVP-CHIEF PHYSICIAN EXEC PRES IMG",
        "authorized_official_telephone_number": "801-442-3495",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2080P0202X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Cardiology",
            "state": "UT",
            "license": "8432010",
            "primary": false
        },
        {
            "code": "2080P0206X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Gastroenterology",
            "state": "UT",
            "license": "8432010",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Utah Valley Rock Canyon Pediatric Specialists",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Provo, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.