Healthcare Provider Details

I. General information

NPI: 1962413690
Provider Name (Legal Business Name): SOUTHWEST UTAH PUBLIC HEALTH DEPARTMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 DL SARGENT DR
CEDAR CITY UT
84720-9342
US

IV. Provider business mailing address

260 DL SARGENT DR
CEDAR CITY UT
84720-9342
US

V. Phone/Fax

Practice location:
  • Phone: 435-586-2437
  • Fax: 435-586-4851
Mailing address:
  • Phone: 435-586-2437
  • Fax: 435-586-4851

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number5244642-3101
License Number StateUT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MRS. AMBER H DAVIS
Title or Position: PUBLIC HEALTH NURSE
Credential: RN
Phone: 435-586-2437