Coral Desert Spine Surgery

Primary specialty

SpecialistTaxonomy code 174400000X

License

5064080-1205 Issued in UT

Legal business name

CORAL DESERT SPINE SURGERY

Practice address

1490 E Foremaster Dr Ste 220
St George, UT 84790-4498

Phone

(435) 656-8366

Fax

(435) 656-8370

NPI assigned

Jun 22, 2011

Organization subpart

No

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

Authorized official

Name

Mr. Ryan D Church, FNP-C

Title

Owner

Phone

(435) 656-8366

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1308700800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1347321600000",
    "number": "1376839902",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1490 E FOREMASTER DR STE 220",
            "city": "ST GEORGE",
            "state": "UT",
            "postal_code": "847904498",
            "telephone_number": "435-656-8366",
            "fax_number": "435-656-8370"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1490 E FOREMASTER DR STE 220",
            "city": "ST GEORGE",
            "state": "UT",
            "postal_code": "847904498",
            "telephone_number": "435-656-8366",
            "fax_number": "435-656-8370"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CORAL DESERT SPINE SURGERY",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-06-22",
        "last_updated": "2012-09-11",
        "status": "A",
        "authorized_official_last_name": "CHURCH",
        "authorized_official_first_name": "RYAN",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "435-656-8366",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "FNP-C"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "UT",
            "license": "5064080-1205",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Coral Desert Foot & Ankle PC
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• Coral Desert Rehabilitation
• Coral Desert Surgery Center LLC
• Macadian Cordova
• Core Chiropractic, LLC
• Corinne W. Draper, LLC
• Jamie Cormani-Denney

• Specialist in St George, UT
• Providers in St George, UT by specialty
• Specialist in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.