Provider Demographics
NPI:1972528537
Name:SOUTH MAIN SURGERY CENTER INC
Entity Type:Organization
Organization Name:SOUTH MAIN SURGERY CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:KENT
Authorized Official - Last Name:BURTON
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:435-628-2671
Mailing Address - Street 1:754 S MAIN ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-5505
Mailing Address - Country:US
Mailing Address - Phone:435-628-2671
Mailing Address - Fax:435-634-1601
Practice Address - Street 1:754 S MAIN ST
Practice Address - Street 2:SUITE 3
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-5505
Practice Address - Country:US
Practice Address - Phone:435-628-2671
Practice Address - Fax:435-634-1601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2015-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT870524073001Medicaid
UT000001018Medicare PIN
UTU000001018Medicare UPIN