Healthcare Provider Details

I. General information

NPI: 1083209589
Provider Name (Legal Business Name): HILLSIDE HEALTH PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2021
Last Update Date: 03/05/2021
Certification Date: 02/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1841 E. RIVERSIDE DR.
ST. GEORGE UT
84790
US

IV. Provider business mailing address

2334 E 3910 S
ST GEORGE UT
84790-5022
US

V. Phone/Fax

Practice location:
  • Phone: 801-850-1110
  • Fax:
Mailing address:
  • Phone: 801-850-1110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. COLBY LOUIS BEAL
Title or Position: VICE PRESIDENT
Credential: DO
Phone: 801-850-1110