Healthcare Provider Details

I. General information

NPI: 1699623058
Provider Name (Legal Business Name): TRUMBULL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2026
Last Update Date: 03/19/2026
Certification Date: 03/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

491 N BLUFF ST
ST GEORGE UT
84770-5923
US

IV. Provider business mailing address

PO BOX 910487
ST GEORGE UT
84791-0487
US

V. Phone/Fax

Practice location:
  • Phone: 602-326-5932
  • Fax:
Mailing address:
  • Phone: 602-326-5932
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name: JEFFREY WEBB
Title or Position: CEO
Credential:
Phone: 602-326-5932