Healthcare Provider Details

I. General information

NPI: 1780214734
Provider Name (Legal Business Name): DIXIE PALLIATIVE CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2020
Last Update Date: 05/01/2020
Certification Date: 05/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

352 E RIVERSIDE DR STE B3B
ST GEORGE UT
84790-5808
US

IV. Provider business mailing address

352 E RIVERSIDE DR STE B3B
ST GEORGE UT
84790-5808
US

V. Phone/Fax

Practice location:
  • Phone: 435-628-8347
  • Fax:
Mailing address:
  • Phone: 435-628-8347
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MELISSA GIUSTINA NIELSEN
Title or Position: ADMIN
Credential:
Phone: 435-628-8347