Provider Demographics
NPI:1023731114
Name:SUPER SONIC HEALTH & WELLNESS, LLC
Entity type:Organization
Organization Name:SUPER SONIC HEALTH & WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BARRETT
Authorized Official - Middle Name:
Authorized Official - Last Name:ST GEORGE
Authorized Official - Suffix:
Authorized Official - Credentials:AUD, PHD
Authorized Official - Phone:520-265-6194
Mailing Address - Street 1:1053 W BLOOMINGTON DR S
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-7567
Mailing Address - Country:US
Mailing Address - Phone:520-265-6194
Mailing Address - Fax:
Practice Address - Street 1:1054 E RIVERSIDE DR STE 201
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-4829
Practice Address - Country:US
Practice Address - Phone:435-688-8991
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-22
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech