Provider Demographics
NPI:1871263061
Name:SOUTHERN UTAH HEART AND VASCULAR
Entity Type:Organization
Organization Name:SOUTHERN UTAH HEART AND VASCULAR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:MUNFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:385-388-8003
Mailing Address - Street 1:6321 S REDWOOD RD STE 102
Mailing Address - Street 2:
Mailing Address - City:TAYLORSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84123-6799
Mailing Address - Country:US
Mailing Address - Phone:385-388-8003
Mailing Address - Fax:
Practice Address - Street 1:2107 W SUNSET BLVD STE 102
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-7140
Practice Address - Country:US
Practice Address - Phone:385-388-8003
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADVANCED VEIN AND VASCULAR OF SOUTHERN UTAH LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-09-17
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty