MEDICARE: SOUTHWEST UTAH COMMUNITY HEALTH CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	308134-1204	UT
2	207Q00000X	Family Medicine Physician	5333623-1204	UT
3	261QF0400X	Federally Qualified Health Center (FQHC)	4921739 0140	UT
4	261QF0400X	Federally Qualified Health Center (FQHC)	4921739-0140	UT

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000057177	OTHER	UT	MEDICARE ID #

General Provider Information

NPI Number	:	1659358687
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHWEST UTAH COMMUNITY HEALTH CENTER

Provider Business Mailing Address
First Line	:	2276 E RIVERSIDE DR
Second Line	:
City	:	ST GEORGE
State	:	UT
Zip	:	84790-2636
Country	:	US
Telephone Number	:	435-879-5101
Fax Number	:	435-628-8945

Provider Business Practice Location Address
First Line	:	2276 E RIVERSIDE DR
Second Line	:
City	:	ST GEORGE
State	:	UT
Zip	:	84790-2636
Country	:	US
Telephone Number	:	435-879-5101
Fax Number	:	435-628-8945

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	MRS. LORI B WRIGHT
Credential	:	MPA
Telephone Number	:	435-879-5101

Provider Enumeration Date	:	12/30/2005
Last Update Date	:	08/31/2022

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Directions to “SOUTHWEST UTAH COMMUNITY HEALTH CENTER ” Practice Location

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