Ihc Health Services Inc
Organization Active NPI Family Medicine Physician · Hyde Park, UT
NPI 1740324581 · NPPES record last updated Aug 29, 2018
Key facts
- NPI
- 1740324581
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 149 (UT)
- Legal business name
- IHC HEALTH SERVICES INC
- Practice address
- 4088 N Highway 91
Hyde Park, UT 84318 - Phone
- (435) 563-4900
- NPI assigned
- Feb 16, 2007
- Organization subpart
- No
Authorized official
- Name
- Dr. Mark Briesacher, MD
- Title
- SVP-Chief Phys Exec/Pres-Imgroup
- Phone
- (801) 442-3495
Practitioners 11
-
Christopher D Black, D.O.
-
Darcie Reasoner Gorman, M.D.
-
Riley McKay Lewis, FNP-BC
-
Leslie Rasch, NP-C
-
Katie Margaret Stokes, APRN
-
Noelle Taylor, DNP
-
Don Howard Van Boerum, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in UT
Medicare enrollment records
| 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 |
National Provider Directory
Locations
551 W Magee Rd
Tucson, AZ 85704
Phone (520) 498-6467
1090 S Roberta St
Salt Lake City, UT 84111
Phone (801) 578-8376
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | 149 | UT | Yes |
| Obstetrics & Gynecology Physician |
207V00000X | 149 | UT |
Addresses
Primary practice location
4088 N Highway 91
Hyde Park, UT 84318
Mailing address
PO Box 27128
Salt Lake City, UT 84127-0128
Phone (435) 563-3222
Other names
- North Cache Valley Clinic
Other providers in Hyde Park, UT
- Kelli Holgate
- Simone Yvonne Holyoak
- Dnell B Howard
- Hyde Park Fitness
- Ihc Health Services Inc
- Nelson Jaco
- Jonathan Terry Jenkins
- Julia Christensen Justis
- April Lee Larkin
- Leanne Loscher Therapy
All providers in Hyde Park, UT · Family Medicine 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 Aug 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.