NPIMap

Organization Active NPI

Ihc Health Services Inc

Doing business as Intermountain Pharmacy #128

  • Community/Retail Pharmacy
  • Salt Lake City, UT
National Provider Identifier
1982711693
Registry record updated Jan 24, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
IHC HEALTH SERVICES INC
Doing business as
Intermountain Pharmacy #128
Practice address
8TH Ave and C St
Salt Lake City, UT 84143-0001
Phone
(801) 408-1019
Fax
(801) 408-5172
NPI assigned
Aug 25, 2006
Last updated
Jan 24, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 24, 2022

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

Authorized official

Name
Nannette Berensen
Title
VP Coo Shared Clinical Services
Phone
(801) 507-8002

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X Primary

Addresses

Primary practice location

8TH Ave and C St
Salt Lake City, UT 84143-0001

Mailing address

PO Box 30013
Salt Lake City, UT 84130-0013

Other identifiers 4

IdentifierTypeStateIssuer
1982711693MedicaidNV
1982711693MedicaidID
1982711693MedicaidUT
2107617OtherPK

Other names 1

  • Intermountain Pharmacy #128 Doing business as

Medicare participation

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

Enrollment records 2

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…
O20100930067899 UT DME Supplier - Pharmacy 1850209420 Practice locations: Salt Lake City, 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 MD485 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 19

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 19

Ownership & related parties

All facility ownership & control disclosures 44

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Intermountain Health Cedar City HospitalCedar City, UT, CCN 460007 Hospital 5% Or Greater Direct Ownership Interest (100%) Jan 1, 1981
Mountain View HospitalIdaho Falls, ID, CCN 130065 Hospital 5% Or Greater Direct Ownership Interest (15%) Mar 31, 2023
Intermountain Health St George Regional HospitalSt George, UT, CCN 460021 Hospital 5% Or Greater Direct Ownership Interest (100%) Apr 1, 1975
Intermountain Health McKay-Dee HospitalOgden, UT, CCN 460004 Hospital 5% Or Greater Direct Ownership Interest
Operational/Managerial Control		 Jan 1, 1976
Jan 1, 1976
Intermountain Health Sevier Valley HospitalRichfield, UT, CCN 460026 Hospital 5% Or Greater Direct Ownership Interest (100%) Jan 1, 1976
Intermountain Health Bear River Valley HospitalTremonton, UT, CCN 460039 Hospital 5% Or Greater Direct Ownership Interest Jul 5, 1995
Intermountain Health Logan Regional HospitalLogan, UT, CCN 460015 Hospital 5% Or Greater Direct Ownership Interest (100%) Jan 1, 1970
Intermountain Health Intermountain Medical CenterMurray, UT, CCN 460010 Hospital 5% Or Greater Direct Ownership Interest (100%) Apr 1, 1975
Intermountain Health Alta View HospitalSandy, UT, CCN 460044 Hospital 5% Or Greater Direct Ownership Interest (100%) Jan 7, 1982
Intermountain Health American Fork HospitalAmerican Fork, UT, CCN 460023 Hospital 5% Or Greater Direct Ownership Interest (100%) Jan 1, 1970
Intermountain Health LDS HospitalSalt Lake City, UT, CCN 460006 Hospital 5% Or Greater Direct Ownership Interest (100%) Jan 1, 1970
Intermountain Health Orem Community HospitalOrem, UT, CCN 460043 Hospital 5% Or Greater Direct Ownership Interest (100%) Apr 1, 1975
Intermountain Health Primary Children's HospitalSalt Lake City, UT, CCN 463301 Hospital 5% Or Greater Direct Ownership Interest (100%) Nov 1, 1980
Intermountain Health Utah Valley HospitalProvo, UT, CCN 460001 Hospital 5% Or Greater Direct Ownership Interest (100%) Apr 1, 1975
Intermountain Health Sanpete Valley HospitalMount Pleasant, UT, CCN 461303 Hospital 5% Or Greater Direct Ownership Interest (100%) Apr 1, 1975
Intermountain Health Cassia Regional HospitalBurley, ID, CCN 131326 Hospital 5% Or Greater Direct Ownership Interest (100%) Apr 1, 1975
Intermountain Health Delta Community HospitalDelta, UT, CCN 461300 Hospital 5% Or Greater Direct Ownership Interest (100%) Apr 1, 1975
Intermountain Health Fillmore Community HospitalFillmore, UT, CCN 461301 Hospital 5% Or Greater Direct Ownership Interest (100%) Jan 1, 1970
Intermountain Health Heber Valley HospitalHeber City, UT, CCN 461307 Hospital 5% Or Greater Direct Ownership Interest (100%) Apr 1, 1975
Delta Community HospitalDelta, UT, CCN 46Z300 Hospital 5% Or Greater Direct Ownership Interest (100%) Dec 29, 2008
Intermountain Health Fillmore Community HospitalFillmore, UT, CCN 46Z301 Hospital 5% Or Greater Direct Ownership Interest (100%) Sep 9, 2008
Heber Valley HospitalHeber City, UT, CCN 46Z307 Hospital 5% Or Greater Direct Ownership Interest
Operational/Managerial Control		 Apr 1, 1975
Apr 1, 1975
Intermountain Medical Center-RehabilitationMurray, UT, CCN 46T010 Hospital 5% Or Greater Direct Ownership Interest (100%) Aug 7, 2007
Ihc Health Services IncSt George, UT, CCN 46T021 Hospital 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control		 Apr 1, 1975
Jan 1, 1976
McKay Dee HospitalOgden, UT, CCN 46T004 Hospital 5% Or Greater Direct Ownership Interest
Operational/Managerial Control		 Jan 1, 1976
Jan 1, 1976
Intermountain Health St George Regional HospitalProvo, UT, CCN 46T001 Hospital 5% Or Greater Direct Ownership Interest (100%) Apr 1, 1975
Sanpete Valley HospitalMt Pleasant, UT, CCN 46Z303 Hospital 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control		 Apr 1, 1975
Apr 1, 1975
Intermountain Health Park City HospitalPark City, UT, CCN 460057 Hospital 5% Or Greater Direct Ownership Interest (100%) Jan 1, 1970
Intermountain Health Riverton HospitalRiverton, UT, CCN 460058 Hospital 5% Or Greater Direct Ownership Interest (100%) Nov 2, 2009
Intermountain Health Garfield Memorial HospitalPanguitch, UT, CCN 461333 Hospital Operational/Managerial Control Jan 1, 2017
Intermountain Health Garfield Memorial HospitalPanguitch, UT, CCN 46Z333 Hospital Operational/Managerial Control Jul 1, 2000
Intermountain Health Layton HospitalLayton, UT, CCN 460061 Hospital 5% Or Greater Direct Ownership Interest (100%) Jan 1, 1970
Idaho Falls Community Hospital LLCIdaho Falls, ID, CCN 130074 Hospital 5% Or Greater Direct Ownership Interest (20%) Mar 31, 2023
Intermountain Health Spanish Fork HospitalSpanish Fork, UT, CCN 460062 Hospital 5% Or Greater Direct Ownership Interest (100%) Jan 1, 1970
Cassia Regional HospitalBurley, ID, CCN 13Z326 Hospital 5% Or Greater Direct Ownership Interest (100%) Apr 1, 1975
Logan Regional Hospital Transitional Care UnitLogan, UT, CCN 465123 Skilled nursing facility Operational/Managerial Control Jul 29, 2008
Intermountain Health Home Health - Mt. PleasantMount Pleasant, UT, CCN 467016 Home health agency 5% Or Greater Direct Ownership Interest (100%) Aug 1, 1980
Intermountain Health Home Health - OgdenOgden, UT, CCN 467004 Home health agency 5% Or Greater Direct Ownership Interest (100%) Jan 1, 1976
Intermountain Health Home Health - St. GeorgeSt George, UT, CCN 467033 Home health agency 5% Or Greater Direct Ownership Interest (100%) Mar 25, 2009
Intermountain Health Hospice - LoganLogan, UT, CCN 461504 Hospice 5% Or Greater Direct Ownership Interest (100%) Oct 1, 2009
Garfield Memorial HospitalPanguitch, UT, CCN 463984 Rural health clinic Operational/Managerial Control Jan 21, 2010
Garfield CountyCircleville, UT, CCN 463980 Rural health clinic Operational/Managerial Control Apr 26, 2010
Bryce Valley ClinicCannonville, UT, CCN 463981 Rural health clinic Operational/Managerial Control Apr 26, 2010
Upper Valley FamilymedicineRigby, ID, CCN 138538 Rural health clinic 5% Or Greater Direct Ownership Interest Apr 7, 2025

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": "1642982400000",
    "number": "1982711693",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8TH AVE AND C ST",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841430001",
            "telephone_number": "801-408-1019",
            "fax_number": "801-408-5172"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IHC HEALTH SERVICES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-25",
        "last_updated": "2022-01-24",
        "certification_date": "2022-01-24",
        "status": "A",
        "authorized_official_last_name": "BERENSEN",
        "authorized_official_first_name": "NANNETTE",
        "authorized_official_title_or_position": "VP COO SHARED CLINICAL SERVICES",
        "authorized_official_telephone_number": "801-507-8002"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1982711693",
            "state": "NV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1982711693",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1982711693",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2107617",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Intermountain Pharmacy #128",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Salt Lake City, UT

Sources for this page

Verify at the official NPI Registry.