Ihc Health Services Inc
Organization Active NPI Allergy & Immunology Physician · Taylorsville, UT
NPI 1710384367 · NPPES record last updated Nov 29, 2018
Key facts
- NPI
- 1710384367
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Allergy & Immunology Physician 207K00000X
- License
- 742462014 (UT)
- Legal business name
- IHC HEALTH SERVICES INC
- Practice address
- 3845 W 4700 S
Taylorsville, UT 84129-3454 - Phone
- (801) 840-8444
- Fax
- (801) 840-2127
- NPI assigned
- Nov 25, 2014
- Organization subpart
- No
Authorized official
- Name
- Mark Briesacher, MD
- Title
- SVP-Chief Exec Phys/Pres-Imgroup
- Phone
- (801) 442-3495
Corporate family (same tax ID) 24
Practitioners 8
-
Emily Bloomquist, PA-C
-
Frank H Brown, MD
-
April Lee Larkin, MD
-
Lindsay Royer, APRN
-
Jessica Ann Ellis, C.N.M
-
Cori Lee Ward, APRN, FNP, PMHNP
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 46D0524320 | Taylorsville Clinic | Compliance | Feb 3, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in UT
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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
- Tax ID family
- Bradley S Thompson DO
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Allergy & Immunology Physician |
207K00000X | 742462014 | UT | Yes |
| Dermatology Physician |
207N00000X | 742462014 | UT |
Addresses
Primary practice location
3845 W 4700 S
Taylorsville, UT 84129-3454
Mailing address
PO Box 27128
Salt Lake City, UT 84127-0128
Phone (801) 840-8444
Other names
- Taylorsville Specialty Clinic
Other providers in Taylorsville, UT
- Ihc Health Services Inc
- Ihc Health Services Inc
- Ihc Health Services Inc
- Ihc Health Services Inc
- Ihc Health Services Inc
- Ihc Health Services Inc
- Imagine Counseling Services
- Frances Imhoff
- In Care We Trust
- Camilla Ingraham
All providers in Taylorsville, UT · Allergy & Immunology Physician in Utah
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 29, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.