Provider Demographics
NPI:1548588247
Name:SOUTHWEST UTAH COMMUNITY HEALTH CENTER, INC
Entity Type:Organization
Organization Name:SOUTHWEST UTAH COMMUNITY HEALTH CENTER, INC
Other - Org Name:CEDAR CITY COMMUNITY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:LORRIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-879-5101
Mailing Address - Street 1:2276 E RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-2636
Mailing Address - Country:US
Mailing Address - Phone:435-986-2565
Mailing Address - Fax:
Practice Address - Street 1:74 W. HARDING AVE
Practice Address - Street 2:
Practice Address - City:CEDAR CITY
Practice Address - State:UT
Practice Address - Zip Code:84720
Practice Address - Country:US
Practice Address - Phone:435-986-2565
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTHWEST UTAH COMMUNITY HEALTH CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-05-06
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT49217390140261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)