Healthcare Provider Details

I. General information

NPI: 1629768676
Provider Name (Legal Business Name): SOUTHWEST UTAH COMMUNITY HEALTH CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2023
Last Update Date: 05/12/2023
Certification Date: 04/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2276 E RIVERSIDE DR.
ST. GEORGE UT
84790-8479
US

IV. Provider business mailing address

2276 E RIVERSIDE DR
ST GEORGE UT
84790-2636
US

V. Phone/Fax

Practice location:
  • Phone: 435-986-2565
  • Fax:
Mailing address:
  • Phone: 435-986-2565
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: KEVIN D. JONES
Title or Position: PHARMACIST IN CHARGE
Credential: RPH
Phone: 435-986-2565