Active NPI
Ihc Health Services Inc
- Community/Retail Pharmacy
- Sandy, UT
National Provider Identifier
1447367164
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Retail Pharmacy
- License
- 10568911-1703
- Legal business name
- IHC HEALTH SERVICES INC
- Practice address
- 9450 S 1300 E
Sandy, UT 84094-5555 - Phone
- (801) 501-2525
- Fax
- (801) 501-2530
- NPI assigned
- Aug 25, 2006
- Organization subpart
- Yes
- Parent organization
- IHC HEALTH SERVICES INC
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Nannette Berensen
- Title
- Vice President of Clinical Systems
- Phone
- (801) 284-1005
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacy | 333600000X | |||
| Community/Retail Pharmacy | 3336C0003X | 10568911-1703 | UT | Primary |
| Compounding Pharmacy | 3336C0004X |
Addresses
Primary practice location
9450 S 1300 E
Sandy, UT 84094-5555
Mailing address
PO Box 30013
Salt Lake City, UT 84130-0013
Phone (801) 501-2525
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1447367164 | Medicaid | UT | |
| 2100774 | Other | PK |
Other names 1
- Intermountain Pharmacy #656
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in UT
Enrollment records 3
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20031105000079 | UT | Part B Supplier - Clinic/Group Practice | 1850209420 |
Receives reassigned benefits from 1,923 practitioners This NPI is an additional NPI on the enrollment |
| 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 |
| O20091117000671 | UT | Part B Supplier - Mass Immunization (Roster Biller Only) | 1850209420 |
26 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Provo, UT; Richfield, UT; Riverton, UT; Roy, UT; Salina, UT; Salt Lake City, UT; Sandy, UT; St George, UT… |
National Provider Directory
National Provider Directory- Part of
- Bradley S Thompson DO
Ownership & related parties
Other NPIs on the same Medicare enrollment 26
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156464000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1531958400000",
"number": "1447367164",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 30013",
"city": "SALT LAKE CITY",
"state": "UT",
"postal_code": "841300013",
"telephone_number": "801-501-2525"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9450 S 1300 E",
"city": "SANDY",
"state": "UT",
"postal_code": "840945555",
"telephone_number": "801-501-2525",
"fax_number": "801-501-2530"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "IHC HEALTH SERVICES INC",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "IHC HEALTH SERVICES INC",
"enumeration_date": "2006-08-25",
"last_updated": "2018-07-19",
"status": "A",
"authorized_official_last_name": "BERENSEN",
"authorized_official_first_name": "NANNETTE",
"authorized_official_title_or_position": "VICE PRESIDENT OF CLINICAL SYSTEMS",
"authorized_official_telephone_number": "801-284-1005"
},
"taxonomies": [
{
"code": "333600000X",
"taxonomy_group": "",
"desc": "Pharmacy",
"state": null,
"license": null,
"primary": false
},
{
"code": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": "UT",
"license": "10568911-1703",
"primary": true
},
{
"code": "3336C0004X",
"taxonomy_group": "",
"desc": "Pharmacy, Compounding Pharmacy",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1447367164",
"state": "UT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PK",
"identifier": "2100774",
"state": null
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Intermountain Pharmacy #656",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Sandy, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2018; 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.