Organization
IHC HEALTH SERVICES INC
Active
Other names
Live Well Center - Utah Valley
Organization subpart
No
Provider details
NPI number
Authorized official
MARK BRIESACHER MD (SVP-CHIEF PHYS EXEC/PRES - IM GROUP)
(801) 442-3495
Entity
Organization
Contact information
Practice address
395 W BULLDOG BLVD, PROVO, UT 84604-3311
(801) 357-4141
Mailing address
PO BOX 27128, SALT LAKE CITY, UT 84127-0128
(801) 357-4141
Taxonomy
Speciality
Code
Description
License number
State
207RS0010X
Sports Medicine (Internal Medicine) Physician
Primary
—
—
2083X0100X
Occupational Medicine Physician
—
—
Other
Enumeration date
02/28/2019
Last updated
07/19/2019
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