Provider Demographics
NPI:1275034084
Name:SOUTHERN UTAH HEALTH & RECOVERY
Entity Type:Organization
Organization Name:SOUTHERN UTAH HEALTH & RECOVERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PART OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ADON
Authorized Official - Middle Name:L
Authorized Official - Last Name:PEARSON
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:435-525-2410
Mailing Address - Street 1:260 W SAINT GEORGE BLVD STE 202B
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-3792
Mailing Address - Country:US
Mailing Address - Phone:435-525-2410
Mailing Address - Fax:
Practice Address - Street 1:260 W SAINT GEORGE BLVD STE 202B
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-3792
Practice Address - Country:US
Practice Address - Phone:435-525-2410
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-27
Last Update Date:2018-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Single Specialty