Provider Demographics
NPI:1407239080
Name:SOUTHERN UTAH NEUROLOGY, INC.
Entity Type:Organization
Organization Name:SOUTHERN UTAH NEUROLOGY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:A
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-668-4618
Mailing Address - Street 1:640 E 700 S
Mailing Address - Street 2:#204
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-5732
Mailing Address - Country:US
Mailing Address - Phone:435-986-4300
Mailing Address - Fax:435-986-4310
Practice Address - Street 1:640 E 700 S
Practice Address - Street 2:#204
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-5732
Practice Address - Country:US
Practice Address - Phone:435-986-4300
Practice Address - Fax:435-986-4310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-01
Last Update Date:2015-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty