Healthcare Provider Details

I. General information

NPI: 1508862947
Provider Name (Legal Business Name): DIXIE SURGERY CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2005
Last Update Date: 11/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1085 S BLUFF ST
ST GEORGE UT
84770-5245
US

IV. Provider business mailing address

1085 S BLUFF ST
ST GEORGE UT
84770-5245
US

V. Phone/Fax

Practice location:
  • Phone: 435-688-2020
  • Fax: 435-634-2646
Mailing address:
  • Phone: 435-688-2020
  • Fax: 435-634-2646

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number62905
License Number StateUT

VIII. Authorized Official

Name: JASON A AHEE
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 435-688-2020