NPIMap

Organization Active NPI

Ihc Health Services Inc

Doing business as Budge Clinic Dermatology

  • Dermatology Physician
  • Logan, UT
National Provider Identifier
1699172122
Registry record updated Jan 27, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
742442014 Issued in UT
Legal business name
IHC HEALTH SERVICES INC
Doing business as
Budge Clinic Dermatology
Practice address
1350 N 500 E
Budge Clinic Dermatology
Logan, UT 84341-2400
Phone
(435) 716-1770
Fax
(435) 716-1727
NPI assigned
Nov 26, 2014
Last updated
Jan 27, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 27, 2017

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

Authorized official

Name
Linda Leckman, MD
Title
Ceo Intermountain Medical Group
Phone
(801) 442-3974

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X 742442014 UT Primary

Addresses

Primary practice location

1350 N 500 E
Budge Clinic Dermatology
Logan, UT 84341-2400

Mailing address

PO Box 27128
Salt Lake City, UT 84127-0128
Phone (435) 716-1770

Other names 1

  • Budge Clinic Dermatology Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID, UT2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040325001015 ID Part B Supplier - Clinic/Group Practice 1850209420 Receives reassigned benefits from 107 practitioners
14 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Idaho Falls, ID; Malad City, ID; Pocatello, ID; Preston, ID; Burley, ID
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

Other NPIs on the same Medicare enrollment 14

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

View all 14

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

1408 Pomerelle Ave
Ste H
Burley, ID 83318
Phone (208) 677-6170

Practitioners & affiliated clinicians

Practitioners 26

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.

View all 26

NPI Registry JSON

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

{
    "created_epoch": "1416960000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1485475200000",
    "number": "1699172122",
    "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": "435-716-1770"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1350 N 500 E",
            "address_2": "BUDGE CLINIC DERMATOLOGY",
            "city": "LOGAN",
            "state": "UT",
            "postal_code": "843412400",
            "telephone_number": "435-716-1770",
            "fax_number": "435-716-1727"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IHC HEALTH SERVICES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-11-26",
        "last_updated": "2017-01-27",
        "status": "A",
        "authorized_official_last_name": "LECKMAN",
        "authorized_official_first_name": "LINDA",
        "authorized_official_title_or_position": "CEO INTERMOUNTAIN MEDICAL GROUP",
        "authorized_official_telephone_number": "801-442-3974",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "UT",
            "license": "742442014",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Budge Clinic Dermatology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Logan, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2017; 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.