Healthcare Provider Details

I. General information

NPI: 1689578049
Provider Name (Legal Business Name): SOUTHERN UTAH PRIMARY AND URGENT CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4617 S PIONEER RD STE 101E
SAINT GEORGE UT
84790-5156
US

IV. Provider business mailing address

4617 S PIONEER RD STE 101E
SAINT GEORGE UT
84790-5156
US

V. Phone/Fax

Practice location:
  • Phone: 435-266-3321
  • Fax: 435-266-3322
Mailing address:
  • Phone: 435-266-3321
  • Fax: 435-266-3322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. BRADLEY JAMES OLSEN
Title or Position: NURSE PRACTIONER
Credential: DNP/FNP-C
Phone: 435-266-3321