Provider Demographics
NPI:1659358687
Name:SOUTHWEST UTAH COMMUNITY HEALTH CENTER
Entity Type:Organization
Organization Name:SOUTHWEST UTAH COMMUNITY HEALTH CENTER
Other - Org Name:FAMILY HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:B
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:MPA
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:435-879-5101
Mailing Address - Fax:435-628-8945
Practice Address - Street 1:2276 E RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-2636
Practice Address - Country:US
Practice Address - Phone:435-879-5101
Practice Address - Fax:435-628-8945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-30
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT308134-1204207Q00000X
UT5333623-1204207Q00000X
UT4921739 0140261QF0400X
UT4921739-0140261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)Group - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000057177OtherMEDICARE ID #
UT461819Medicare Oscar/Certification
X85459Medicare UPIN
UTX85459Medicare UPIN
000057177Medicare PIN
UT000057177Medicare PIN