Provider Demographics
NPI:1306841606
Name:SOUTHWEST UTAH PUBLIC HEALTH DEPT
Entity Type:Organization
Organization Name:SOUTHWEST UTAH PUBLIC HEALTH DEPT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR HEALTH OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:BLODGETT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:435-673-3528
Mailing Address - Street 1:620 S 400 E STE 400
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-7063
Mailing Address - Country:US
Mailing Address - Phone:435-673-3528
Mailing Address - Fax:435-628-6642
Practice Address - Street 1:620 S 400 E STE 400
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-7063
Practice Address - Country:US
Practice Address - Phone:435-673-3528
Practice Address - Fax:435-628-6425
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-15
Last Update Date:2008-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT*0081Medicaid
UTPRA03223OtherMOLINA
UT33255OtherPEHP
UT103000705103OtherIHC
UT35570OtherDESERET MUTUAL
UT010007072OtherRAILROAD MEDICARE
UT010007072OtherRAILROAD MEDICARE
UT=========00001OtherBLUE CROSS BLUE SHIELD
UT*0081Medicaid