Healthcare Provider Details

I. General information

NPI: 1043951742
Provider Name (Legal Business Name): CM6, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2022
Last Update Date: 04/05/2022
Certification Date: 04/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2743 E 3580 S
SAINT GEORGE UT
84790-7284
US

IV. Provider business mailing address

2743 E 3580 S
SAINT GEORGE UT
84790-7284
US

V. Phone/Fax

Practice location:
  • Phone: 818-903-9006
  • Fax:
Mailing address:
  • Phone: 818-903-9006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name: CORBIN MICHAEL ALLRED
Title or Position: OWNER / PHYSICIAN ASSISTANT
Credential: PA-C, MPAS
Phone: 818-903-9006