Provider Demographics
NPI:1740260504
Name:CEDAR RIDGE FAMILY MEDICINE
Entity type:Organization
Organization Name:CEDAR RIDGE FAMILY MEDICINE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:R
Authorized Official - Last Name:NEWMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:435-586-7676
Mailing Address - Street 1:110 WEST 1325 NORTH
Mailing Address - Street 2:#200
Mailing Address - City:CEDAR CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84720
Mailing Address - Country:US
Mailing Address - Phone:435-586-7676
Mailing Address - Fax:435-586-2290
Practice Address - Street 1:110 WEST 1325 NORTH
Practice Address - Street 2:#200
Practice Address - City:CEDAR CITY
Practice Address - State:UT
Practice Address - Zip Code:84720
Practice Address - Country:US
Practice Address - Phone:435-586-7676
Practice Address - Fax:435-586-2290
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CEDAR RIDGE FAMILY MEDICINE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-01-18
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT50914131205207Q00000X
261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT529727490005Medicaid
UT529727490005Medicaid
005786501Medicare ID - Type Unspecified