=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952285181
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | STGI HEALTH, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/01/2025
-----------------------------------------------------
Last Update Date | 08/01/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2126 OPAL AVE
-----------------------------------------------------
City | YELLOWSTONE NATIONAL PARK
-----------------------------------------------------
State | WY
-----------------------------------------------------
Zip | 82190
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 307-344-4965
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2900 S QUINCY ST STE 888
-----------------------------------------------------
City | ARLINGTON
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22206-2233
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PROJECT MANAGER
-----------------------------------------------------
Name | SUZANNE SUZANNE KANG
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 703-578-6030
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------