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General NPI Number Information
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NPI Number | 1689578049
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Entity Type | Organization
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Legal Business Name | SOUTHERN UTAH PRIMARY AND URGENT CARE
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Dates
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Enumeration Date | 10/07/2026
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Last Update Date | 10/07/2026
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Provider Practice Location Address
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Address Line | 4617 S PIONEER RD STE 101E
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City | SAINT GEORGE
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State | UT
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Zip | 84790-5156
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Country | US
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Telephone | 435-266-3321
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Fax | 435-266-3322
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Provider Business Mailing Address
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Address Line | 4617 S PIONEER RD STE 101E
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City | SAINT GEORGE
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State | UT
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Zip | 84790-5156
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Country | US
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Telephone | 435-266-3321
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Fax | 435-266-3322
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Authorized Official
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Title or Position | NURSE PRACTIONER
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Name | MR. BRADLEY JAMES OLSEN
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Credential | DNP/FNP-C
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Telephone | 435-266-3321
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State | NULL
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