Coral Desert Surgery Center LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

2005-ASF-52092 Issued in UT

Legal business name

CORAL DESERT SURGERY CENTER LLC

Practice address

1490 E Foremaster Dr
Building C
St George, UT 84790-4488

Phone

(435) 674-5230

Fax

(435) 674-5231

NPI assigned

Apr 17, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dan Nielson

Title

Administrator

Phone

(435) 674-5230

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in UT

Enrollment records 1

Listed as

Coral Desert Surgery Center LLCCCN 46C0001036

Medicare certification status

ActiveFrom the Provider of Services file

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1145232000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1496966400000",
    "number": "1346205176",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1490 E FOREMASTER DR",
            "address_2": "BUILDING C",
            "city": "ST GEORGE",
            "state": "UT",
            "postal_code": "847904488",
            "telephone_number": "435-674-5230",
            "fax_number": "435-674-5231"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1490 E FOREMASTER DR",
            "address_2": "BUILDING C",
            "city": "ST GEORGE",
            "state": "UT",
            "postal_code": "847904488",
            "telephone_number": "435-674-5230",
            "fax_number": "435-674-5231"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CORAL DESERT SURGERY CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-17",
        "last_updated": "2017-06-09",
        "status": "A",
        "authorized_official_last_name": "NIELSON",
        "authorized_official_first_name": "DAN",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "435-674-5230"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "UT",
            "license": "2005-ASF-52092",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00085628",
            "state": "UT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "838112",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Ambulatory Surgical Clinic/Center in St George, UT
• Providers in St George, UT by specialty
• Ambulatory Surgical Clinic/Center in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.