Basic Information
| Provider Information | |||||||||
| NPI: | 1043257538 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | IHC HEALTH SERVICES, INC | ||||||||
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| OtherOrganizationName: | FILLMORE COMMUNITY HOSPITAL | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 30180 | ||||||||
| Address2: | |||||||||
| City: | SALT LAKE CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841300180 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8013577027 | ||||||||
| FaxNumber: | 8013577997 | ||||||||
| Practice Location | |||||||||
| Address1: | 674 S HIGHWAY 99 | ||||||||
| Address2: | |||||||||
| City: | FILLMORE | ||||||||
| State: | UT | ||||||||
| PostalCode: | 846315013 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4357435591 | ||||||||
| FaxNumber: | 4357436312 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/01/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | WILEY | ||||||||
| AuthorizedOfficialFirstName: | CRAIG | ||||||||
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| AuthorizedOfficialTitleorPosition: | PAS, MGR | ||||||||
| AuthorizedOfficialTelephone: | 8013577027 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | UT | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.