Healthcare Provider Details

I. General information

NPI: 1659358687
Provider Name (Legal Business Name): SOUTHWEST UTAH COMMUNITY HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2005
Last Update Date: 08/31/2022
Certification Date: 08/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2276 E RIVERSIDE DR
ST GEORGE UT
84790-2636
US

IV. Provider business mailing address

2276 E RIVERSIDE DR
ST GEORGE UT
84790-2636
US

V. Phone/Fax

Practice location:
  • Phone: 435-879-5101
  • Fax: 435-628-8945
Mailing address:
  • Phone: 435-879-5101
  • Fax: 435-628-8945

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number308134-1204
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5333623-1204
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number4921739 0140
License Number StateUT
# 4
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number4921739-0140
License Number StateUT

VIII. Authorized Official

Name: MRS. LORI B WRIGHT
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: MPA
Phone: 435-879-5101