Provider Demographics
NPI:1225156680
Name:EPIC CORPORATION
Entity Type:Organization
Organization Name:EPIC CORPORATION
Other - Org Name:ELITE CORPORATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:IVAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DUNLAP
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:435-673-5117
Mailing Address - Street 1:620 S 400 E
Mailing Address - Street 2:STE 208
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-3700
Mailing Address - Country:US
Mailing Address - Phone:435-673-5117
Mailing Address - Fax:435-652-4604
Practice Address - Street 1:676 S BLUFF ST
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-3596
Practice Address - Country:US
Practice Address - Phone:435-673-5117
Practice Address - Fax:435-652-4604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT199478-4406367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty