Healthcare Provider Details

I. General information

NPI: 1467002287
Provider Name (Legal Business Name): SOUTHWEST UT PUBLIC HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2019
Last Update Date: 09/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6205 400 E SUITE 400
SAINT GEORGE UT
84770-3700
US

IV. Provider business mailing address

6205 400 E. SUITE 400
SAINT GEORGE UT
84770-3700
US

V. Phone/Fax

Practice location:
  • Phone: 435-652-4078
  • Fax: 435-628-6425
Mailing address:
  • Phone: 435-652-4078
  • Fax: 435-628-6425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number State

VIII. Authorized Official

Name: JEFF SHUMWAY
Title or Position: BUSINESS MANAGER
Credential:
Phone: 435-673-3528