Healthcare Provider Details

I. General information

NPI: 1316989825
Provider Name (Legal Business Name): SOUTHEASTERN UTAH ASSOCIATION OF LOCAL GOVERNMENTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 S CARBON AVE
PRICE UT
84501-2909
US

IV. Provider business mailing address

375 S CARBON AVE
PRICE UT
84501-2909
US

V. Phone/Fax

Practice location:
  • Phone: 435-637-5444
  • Fax: 435-637-5448
Mailing address:
  • Phone: 435-637-5444
  • Fax: 435-637-5448

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateUT

VIII. Authorized Official

Name: MR. MAUGHAN MARION GUYMON
Title or Position: DIRECTOR
Credential:
Phone: 435-637-4268