Basic Information
| Provider Information | |||||||||
| NPI: | 1891932422 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | IHC HEALTH SERVICES INC | ||||||||
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| OtherOrganizationName: | CRMC SPRING CREEK WOMENS HEALTH | ||||||||
| OtherOrganizationType: | 4 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 27128 | ||||||||
| Address2: | |||||||||
| City: | SALT LAKE CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841270128 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8014421400 | ||||||||
| FaxNumber: | 8014420643 | ||||||||
| Practice Location | |||||||||
| Address1: | 1408 POMERELLE | ||||||||
| Address2: | SUITE H | ||||||||
| City: | BURLEY | ||||||||
| State: | ID | ||||||||
| PostalCode: | 833182682 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2088784970 | ||||||||
| FaxNumber: | 2088784974 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/20/2009 | ||||||||
| LastUpdateDate: | 02/11/2009 | ||||||||
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| AuthorizedOfficialLastName: | HOWARD | ||||||||
| AuthorizedOfficialFirstName: | KELLY | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 8014421425 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.