Provider Demographics
NPI:1457774622
Name:EAST WEST HEALTH
Entity Type:Organization
Organization Name:EAST WEST HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:REGAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:ARCHIBALD
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:801-230-1611
Mailing Address - Street 1:560 ASPEN DR
Mailing Address - Street 2:
Mailing Address - City:PARK CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84098-5137
Mailing Address - Country:US
Mailing Address - Phone:801-230-1611
Mailing Address - Fax:
Practice Address - Street 1:393 E RIVERSIDE DR STE 2B
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-7048
Practice Address - Country:US
Practice Address - Phone:435-773-7790
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-24
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7967318-1201171100000X
UT6592169-1205208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty