Healthcare Provider Details

I. General information

NPI: 1659314268
Provider Name (Legal Business Name): FIVE COUNTY ASSOCIATION OF GOVERNMENTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1070 WEST 1600 SOUTH BLD B
ST. GEORGE UT
84770
US

IV. Provider business mailing address

PO BOX 1550
ST GEORGE UT
84771-1550
US

V. Phone/Fax

Practice location:
  • Phone: 435-673-3548
  • Fax: 435-673-3540
Mailing address:
  • Phone: 435-673-3548
  • Fax: 435-673-3540

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. KENNETH L SIZEMORE
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 435-673-3548