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General NPI Number Information
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NPI Number | 1275034084
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Entity Type | Organization
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Legal Business Name | SOUTHERN UTAH HEALTH & RECOVERY
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Dates
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Enumeration Date | 02/27/2018
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Last Update Date | 02/27/2018
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Provider Practice Location Address
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Address Line | 260 W SAINT GEORGE BLVD STE 202B
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City | ST GEORGE
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State | UT
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Zip | 84770-3792
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Country | US
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Telephone | 435-525-2410
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Fax |
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Provider Business Mailing Address
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Address Line | 260 W SAINT GEORGE BLVD STE 202B
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City | ST GEORGE
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State | UT
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Zip | 84770-3792
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Country | US
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Telephone | 435-525-2410
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Fax |
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Authorized Official
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Title or Position | PART OWNER
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Name | ADON L. PEARSON
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Credential | PA-C
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Telephone | 435-525-2410
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0401X
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Taxonomy Name | Addiction Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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