1306841606 NPI number — SOUTHWEST UTAH PUBLIC HEALTH DEPT

Table of content: (NPI 1306841606)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306841606 NPI number — SOUTHWEST UTAH PUBLIC HEALTH DEPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTHWEST UTAH PUBLIC HEALTH DEPT
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1306841606
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/08/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
620 S 400 E STE 400
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ST GEORGE
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84770-7063
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
435-673-3528
Provider Business Mailing Address Fax Number:
435-628-6642

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
620 S 400 E STE 400
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ST GEORGE
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84770-7063
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
435-673-3528
Provider Business Practice Location Address Fax Number:
435-628-6425
Provider Enumeration Date:
06/15/2005

Additional Information

Authorized Official

Authorized Official Last Name:
BLODGETT
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR HEALTH OFFICER
Authorized Official Telephone Number:
435-673-3528

Provider Taxonomy Codes

  • Taxonomy code: 251K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: *0081 , issued by the state of ( UT ) . This identifiers is of the category "MEDICAID".
  • Identifier: PRA03223 . This is a "MOLINA" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 33255 . This is a "PEHP" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 103000705103 . This is a "IHC" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 35570 . This is a "DESERET MUTUAL" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
  • Identifier: 010007072 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".




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