Healthcare Provider Details

I. General information

NPI: 1457793697
Provider Name (Legal Business Name): HUNTSMAN WEST SPINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2013
Last Update Date: 10/19/2021
Certification Date: 10/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 N 1680 E STE I-1
SAINT GEORGE UT
84790-2579
US

IV. Provider business mailing address

617 E RIVERSIDE DR STE 302
ST GEORGE UT
84790-8722
US

V. Phone/Fax

Practice location:
  • Phone: 435-652-6024
  • Fax: 435-652-6025
Mailing address:
  • Phone: 435-652-6024
  • Fax: 435-652-6025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number8635840-1205
License Number StateUT

VIII. Authorized Official

Name: KRISTOFFER R WEST
Title or Position: MEMBER / MANAGER
Credential: MD
Phone: 435-652-6024