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General NPI Number Information
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NPI Number | 1629568209
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Entity Type | Organization
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Legal Business Name | CORNER CLINIC ST GEORGE LLC
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Dates
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Enumeration Date | 05/18/2018
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Last Update Date | 08/05/2022
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Provider Practice Location Address
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Address Line | 2351 S RIVER RD UNIT 5
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City | ST GEORGE
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State | UT
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Zip | 84790-8280
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Country | US
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Telephone | 435-659-7352
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Fax |
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Provider Business Mailing Address
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Address Line | 2351 S RIVER RD UNIT 5
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City | ST GEORGE
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State | UT
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Zip | 84790-8280
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Country | US
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Telephone | 435-659-7352
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Fax |
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Authorized Official
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Title or Position | COO
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Name | SHANE WHITTIER
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Credential |
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Telephone | 435-709-8786
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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