1073988077 NPI number — SOUTHWEST UTAH COMMUNITY HEALTH CENTER

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073988077 NPI number — SOUTHWEST UTAH COMMUNITY HEALTH CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTHWEST UTAH COMMUNITY HEALTH CENTER
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:
D/B/A FAMILY HEALTHCARE
Provider Other Organization Name Type Code:
3
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:
1073988077
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/01/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2276 E RIVERSIDE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT GEORGE
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84790-2636
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
435-986-2565
Provider Business Mailing Address Fax Number:
435-986-2577

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
245 EAST 680 SOUTH
Provider Second Line Business Practice Location Address:
FAMILY HEALTHCARE CENTER EAST CLINIC
Provider Business Practice Location Address City Name:
CEDAR CITY
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84720
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
435-865-1387
Provider Business Practice Location Address Fax Number:
435-865-6357
Provider Enumeration Date:
12/02/2015

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
WRIGHT
Authorized Official First Name:
LORRAINE
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
435-879-5101

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 461846 . This is a "UGS" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".