MEDICARE: EDWARD G. SOUTHWICK, M.D., P.C.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	071157009	OTHER	UT	RAILROAD MEDICARE

General Provider Information

NPI Number	:	1215287503
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EDWARD G. SOUTHWICK, M.D., P.C.

Provider Business Mailing Address
First Line	:	3465 S 4155 W
Second Line	:	SUITE 1
City	:	WEST VALLEY CITY
State	:	UT
Zip	:	84120-2076
Country	:	US
Telephone Number	:	801-966-1403
Fax Number	:	801-964-6478

Provider Business Practice Location Address
First Line	:	3465 S 4155 W
Second Line	:	SUITE 1
City	:	WEST VALLEY CITY
State	:	UT
Zip	:	84120-2076
Country	:	US
Telephone Number	:	801-966-1403
Fax Number	:	801-964-6478

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. EDWARD GLEN SOUTHWICK
Credential	:	M.D.
Telephone Number	:	801-966-1403

Provider Enumeration Date	:	09/13/2012
Last Update Date	:	09/13/2012

Similar Medicare Providers

1497832083 — DR. LYSA CHARLES MD
Practice Location Address:

2101 E JEFFERSON ST PPQA MEDICARE COMPLIANCE UNT 6 WEST , KAISER PERMANENTE MID ATLANTIC PERMANENTE MEDICAL GROUP
ROCKVILLE, MD
20852-4908

Practice Phone: 301-816-6660
Practice Fax: 301-816-6308

1225073588 — VALLEY ASSOCIATED UROLOGY MEDICARE GROUP INC
Practice Location Address:

200 COTTAGE AVE , STE 101
MANTECA, CA
95336-4935

Practice Phone: 209-239-2197
Practice Fax: 209-239-7672

1619957156 — DR. EDWARD G SOUTHWICK M.D.
Practice Location Address:

3465 S 4155 W , SUITE #1
WEST VALLEY CITY, UT
84120-2076

Practice Phone: 801-966-1403
Practice Fax: 801-964-6478

1003935826 — WESTVALLEYOPTICALINC
Practice Location Address:

3465 PIONEER PKWY , SUITE 3
WEST VALLEY CITY, UT
84120-2076

Practice Phone: 801-963-9335
Practice Fax: 801-963-1161

1689794182 — MRS. PAMELA CAROL CHRISTENSEN FNP
Practice Location Address:

3465 PIONEER PKWY , STE 2
WEST VALLEY CITY, UT
84120-2076

Practice Phone: 801-963-7636
Practice Fax: 801-963-8130

1326263773 — BENITA MEDICAL LLC
Practice Location Address:

3465 PIONEER PKWY , STE 2
WEST VALLEY CITY, UT
84120-2076

Practice Phone: 801-963-7636
Practice Fax: 801-963-8130

Directions to “EDWARD G. SOUTHWICK, M.D., P.C. ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.