Healthcare Provider Details

I. General information

NPI: 1356444863
Provider Name (Legal Business Name): ST GEORGE SURGICAL CENTER LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2006
Last Update Date: 09/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

676 S BLUFF ST
ST GEORGE UT
84770-3596
US

IV. Provider business mailing address

676 S BLUFF ST
ST GEORGE UT
84770-3596
US

V. Phone/Fax

Practice location:
  • Phone: 435-673-8080
  • Fax: 435-673-0096
Mailing address:
  • Phone: 435-673-8080
  • Fax: 435-673-0096

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number5566449-1205
License Number StateUT

VIII. Authorized Official

Name: CORLAND TY TIPPETS
Title or Position: ADMINISTRATOR
Credential:
Phone: 435-673-8080