NPIMap

Organization Active NPI

Ihc Health Services Inc

Doing business as Intermountain Southridge Pharmacy

  • Community/Retail Pharmacy
  • Riverton, UT
National Provider Identifier
1649401969
Registry record updated Jul 19, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
7359499-1703 Issued in UT
Legal business name
IHC HEALTH SERVICES INC
Doing business as
Intermountain Southridge Pharmacy
Practice address
3723 W 12600 S Ste 170
Riverton, UT 84065-7296
Phone
(801) 285-4500
Fax
(801) 285-4501
NPI assigned
Aug 4, 2009
Last updated
Jul 19, 2018By the provider in NPPES
Organization subpart
Yes
Parent organization
IHC HEALTH SERVICES INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 19, 2018

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)CodeLicenseStatePrimary
Pharmacy 333600000X NU
Community/Retail Pharmacy 3336C0003X 7359499-1703 UT Primary
Compounding Pharmacy 3336C0004X NU

Addresses

Primary practice location

3723 W 12600 S Ste 170
Riverton, UT 84065-7296

Mailing address

PO Box 30013
Salt Lake City, UT 84130-0013
Phone (801) 285-4500

Other identifiers 4

IdentifierTypeStateIssuer
1649401969MedicaidUT
1649401969MedicaidID
2121208OtherPK
1649401969MedicaidWY

Other names 1

  • Intermountain Southridge Pharmacy Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
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…

Other NPIs on the same Medicare enrollment 26

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 26

National Provider Directory

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

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

3723 W 12600 S
Ste 170
Riverton, UT 84065
Phone (801) 285-4500

Practitioners & affiliated clinicians

Practitioners 4

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": "1249344000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1531958400000",
    "number": "1649401969",
    "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": "801-285-4500",
            "fax_number": "801-442-3133"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3723 W 12600 S STE 170",
            "city": "RIVERTON",
            "state": "UT",
            "postal_code": "840657296",
            "telephone_number": "801-285-4500",
            "fax_number": "801-285-4501"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IHC HEALTH SERVICES INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "IHC HEALTH SERVICES INC",
        "enumeration_date": "2009-08-04",
        "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": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "UT",
            "license": "7359499-1703",
            "primary": true
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1649401969",
            "state": "UT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1649401969",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2121208",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1649401969",
            "state": "WY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Intermountain Southridge Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Riverton, 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.

Verify at the official NPI Registry.