Basic Information
| Provider Information | |||||||||
| NPI: | 1891237640 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | FAMILY HEALTHCARE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 189 N MAIN ST | ||||||||
| Address2: | |||||||||
| City: | ST GEORGE | ||||||||
| State: | UT | ||||||||
| PostalCode: | 847702823 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4359862565 | ||||||||
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| Practice Location | |||||||||
| Address1: | 245 E 680 S | ||||||||
| Address2: | |||||||||
| City: | CEDAR CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 847203593 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4358651387 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/10/2016 | ||||||||
| LastUpdateDate: | 11/10/2016 | ||||||||
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| AuthorizedOfficialLastName: | VAIFANUA | ||||||||
| AuthorizedOfficialFirstName: | HOWARD | ||||||||
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| AuthorizedOfficialTitleorPosition: | HUMAN RESOURCES | ||||||||
| AuthorizedOfficialTelephone: | 4359862565 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 124Q00000X | 9818312-9920 | UT | Y | 193200000X MULTI-SPECIALTY GROUP | Dental Providers | Dental Hygienist |
No ID Information.