MEDICARE: SOUTHWEST SURGICAL ASSOCIATES

Medicare Provider Information

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	184553-1205	UT

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

NPI Number	:	1023181625
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHWEST SURGICAL ASSOCIATES

Provider Business Mailing Address
First Line	:	1490 E FOREMASTER DR STE 200
Second Line	:
City	:	ST GEORGE
State	:	UT
Zip	:	84790-4496
Country	:	US
Telephone Number	:	435-628-1641
Fax Number	:	435-628-1660

Provider Business Practice Location Address
First Line	:	1490 E FOREMASTER DR STE 200
Second Line	:
City	:	ST GEORGE
State	:	UT
Zip	:	84790-4496
Country	:	US
Telephone Number	:	435-628-1641
Fax Number	:	435-628-1660

Authorized Official
Title or Position	:	PRESIDENT
Name	:	BRAD A MYERS
Credential	:	MD
Telephone Number	:	435-628-1641

Provider Enumeration Date	:	11/15/2006
Last Update Date	:	08/22/2020

1490 E FOREMASTER DR STE 200
SAINT GEORGE, UT
84790-4496

Practice Phone: 435-628-1641
Practice Fax: 435-628-1660