Healthcare Provider Details

I. General information

NPI: 1740260504
Provider Name (Legal Business Name): CEDAR RIDGE FAMILY MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2006
Last Update Date: 10/11/2024
Certification Date: 10/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 WEST 1325 NORTH #200
CEDAR CITY UT
84720
US

IV. Provider business mailing address

110 WEST 1325 NORTH #200
CEDAR CITY UT
84720
US

V. Phone/Fax

Practice location:
  • Phone: 435-586-7676
  • Fax: 435-586-2290
Mailing address:
  • Phone: 435-586-7676
  • Fax: 435-586-2290

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number50914131205
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: STEVEN R NEWMAN
Title or Position: OWNER
Credential: MD
Phone: 435-586-7676