Provider Demographics
NPI:1912048521
Name:CCIOWH PRACTICE MANAGEMENT
Entity Type:Organization
Organization Name:CCIOWH PRACTICE MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:SANDERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:435-865-9500
Mailing Address - Street 1:110 W 1325 N
Mailing Address - Street 2:SUITE 300
Mailing Address - City:CEDAR CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84720-8174
Mailing Address - Country:US
Mailing Address - Phone:435-865-9500
Mailing Address - Fax:435-586-8995
Practice Address - Street 1:110 W 1325 N
Practice Address - Street 2:SUITE 300
Practice Address - City:CEDAR CITY
Practice Address - State:UT
Practice Address - Zip Code:84720-8174
Practice Address - Country:US
Practice Address - Phone:435-865-9500
Practice Address - Fax:435-586-8995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5033683-1205207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty