Healthcare Provider Details

I. General information

NPI: 1821759705
Provider Name (Legal Business Name): VINEYARD SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2022
Last Update Date: 02/15/2023
Certification Date: 02/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

691 E 400 N STE 100
VINEYARD UT
84059-7509
US

IV. Provider business mailing address

PO BOX 912042
ST GEORGE UT
84791-2042
US

V. Phone/Fax

Practice location:
  • Phone: 385-327-0930
  • Fax: 385-327-0931
Mailing address:
  • Phone: 435-215-0228
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RYAN LECHEMINANT
Title or Position: ADMINISTRATOR
Credential:
Phone: 385-203-0246