Provider Demographics
NPI:1831815984
Name:ST GEORGE HEART AND VASCULAR
Entity type:Organization
Organization Name:ST GEORGE HEART AND VASCULAR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:NEEDHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:406-690-2008
Mailing Address - Street 1:1841 E RIVERSIDE DR STE 102
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-7063
Mailing Address - Country:US
Mailing Address - Phone:435-900-6001
Mailing Address - Fax:
Practice Address - Street 1:1841 E RIVERSIDE DR STE 102
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-7063
Practice Address - Country:US
Practice Address - Phone:406-690-2008
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-19
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty