Provider Demographics
NPI:1609046853
Name:CALLAHAN CLINIC, PC
Entity Type:Organization
Organization Name:CALLAHAN CLINIC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:DEE
Authorized Official - Last Name:CALLAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:435-656-5323
Mailing Address - Street 1:1240 E 100 S
Mailing Address - Street 2:SUITE 15-A
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-3001
Mailing Address - Country:US
Mailing Address - Phone:435-656-5323
Mailing Address - Fax:435-656-5127
Practice Address - Street 1:1240 E 100 S
Practice Address - Street 2:SUITE 15-A
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-3001
Practice Address - Country:US
Practice Address - Phone:435-656-5323
Practice Address - Fax:435-656-5127
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-04
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1594201205208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty