=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952456907
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RED ROCK NEUROPSYCHIATRY PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/23/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1240 E 100 S SUITE 15A
-----------------------------------------------------
City | ST GEORGE
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84790-3001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 435-656-2459
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1240 E 100 S SUITE 15A
-----------------------------------------------------
City | ST GEORGE
-----------------------------------------------------
State | UT
-----------------------------------------------------
Zip | 84790-3001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 435-656-2459
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. KENT ROUNDY
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 435-656-2459
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | 5852286-1205
-----------------------------------------------------
License Number State | UT
-----------------------------------------------------