Basic Information
| Provider Information | |||||||||
| NPI: | 1194749580 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | IHC HEALTH SERVICES, INC. | ||||||||
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| OtherOrganizationName: | MCKAY DEE HOSPITAL | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4646 LAKE PARK BLVD | ||||||||
| Address2: | |||||||||
| City: | SALT LAKE CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841208212 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8014428468 | ||||||||
| FaxNumber: | 8014420066 | ||||||||
| Practice Location | |||||||||
| Address1: | 4401 HARRISON BLVD | ||||||||
| Address2: | |||||||||
| City: | OGDEN | ||||||||
| State: | UT | ||||||||
| PostalCode: | 844033195 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8013872800 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/27/2006 | ||||||||
| LastUpdateDate: | 01/26/2011 | ||||||||
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| AuthorizedOfficialLastName: | SMITH | ||||||||
| AuthorizedOfficialFirstName: | DOUG | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF FINANCIAL OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 8013873713 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 273R00000X | 2006-HOSP-191 | UT | N | Hospital Units | Psychiatric Unit | 273Y00000X | 2006-HOSP-191 | UT | N | Hospital Units | Rehabilitation Unit | 314000000X | 2006-HOSP-191 | UT | N | Nursing & Custodial Care Facilities | Skilled Nursing Facility | 282N00000X | 2006-HOSP-191 | UT | Y | Hospitals | General Acute Care Hospital |
No ID Information.