Southwest Skin and Cancer LLC

Primary specialty

SpecialistTaxonomy code 174400000X

Legal business name

SOUTHWEST SKIN AND CANCER LLC

Practice address

383 S 300 E
St George, UT 84770-3620

Phone

(435) 628-2826

Fax

(435) 628-2839

NPI assigned

May 17, 2006

Last updated

Feb 14, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

W Bret Smith, MDNPI 1164499836

Title

Partner and Owner

Phone

(435) 628-2826

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in UT, NV2 enrollments

Enrollment records 2

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

Practitioners 17

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Bradley Evanson

  • Dermatology Physician
  • St George, UT
  • NPI 1689069312

  NV

  Medicare reassignment Care Compare group NPD
• W Bret Smith, MD

  • Dermatology Physician
  • St George, UT
  • NPI 1164499836
  Medicare reassignment NPD Authorized official
• Wallace Austin Smith, M.D.

  • Dermatology Physician
  • St George, UT
  • NPI 1376800532

  NV

  Medicare reassignment Care Compare group NPD
• Scott Condie, P.A.-C

  • Physician Assistant
  • St George, UT
  • NPI 1891749560
  Medicare reassignment Care Compare group
• Kyle James Eardley, PA-C

  • Physician Assistant
  • St George, UT
  • NPI 1376369231
  Medicare reassignment Care Compare group
• Greg Robert Jacobsen, M.D.

  • Dermatology Physician
  • St George, UT
  • NPI 1811105745
  Medicare reassignment Care Compare group
• Tim Nowatzke, P.A.-C

  • Physician Assistant
  • St George, UT
  • NPI 1215989645
  Medicare reassignment Care Compare group
• Darin Thomas Smith, P.A.-C.

  • Physician Assistant
  • Tooele, UT
  • NPI 1538375415

  NV

  Medicare reassignment Care Compare group
• Marcus Pace, PA

  • Physician Assistant
  • Henderson, NV
  • NPI 1083017081

  UT

  Medicare reassignment Care Compare group
• David Woodbury, PA

  • Physician Assistant
  • Blackfoot, ID
  • NPI 1598136368

  UT

  Medicare reassignment
• Robin Berger, MD

  • Procedural Dermatology Physician
  • St George, UT
  • NPI 1275557407
  NPD (past)
• Cortney A Bernardo, PAC

  • Medical Physician Assistant
  • St George, UT
  • NPI 1285735688
  NPD (past)

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

{
    "created_epoch": "1147824000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1707868800000",
    "number": "1619929783",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "383 S 300 E",
            "city": "ST GEORGE",
            "state": "UT",
            "postal_code": "847703620",
            "telephone_number": "435-628-2826",
            "fax_number": "435-628-2839"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "383 S 300 E",
            "city": "ST GEORGE",
            "state": "UT",
            "postal_code": "847703620",
            "telephone_number": "435-628-2826",
            "fax_number": "435-628-2839"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "254 South 1470 East",
            "address_2": "102",
            "address_purpose": "LOCATION",
            "city": "St George",
            "state": "UT",
            "postal_code": "84790",
            "country_code": "US",
            "telephone_number": "435-628-2826",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SOUTHWEST SKIN AND CANCER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-17",
        "last_updated": "2024-02-14",
        "certification_date": "2024-02-13",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "W",
        "authorized_official_middle_name": "BRET",
        "authorized_official_title_or_position": "PARTNER AND OWNER",
        "authorized_official_telephone_number": "435-628-2826",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Southwest Dysphagia Solutions, Professional Corporation
• Southwest Internal Medicine, P. C.
• Southwest Medical Supplies, LLC
• Southwest Musculoskeletal Medicine Clinic PC
• Southwest Neurological Rehabilitation Center
• Southwest Spine and Pain Care Specialists LLC (Southwest Healing and Wellness Center)
• Southwest Spine and Pain Care Specialists, LLC (Physicians Laboratory Services)
• Southwest Spine and Pain Care Specialists, LLC (Physician Laboratory Services)
• Southwest Spine and Pain Care Specialists, LLC (Vista Spine Sports and Injury Center)
• Southwest Surgery Center LLC

• 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 Feb 14, 2024; 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.