Nic - St George, LLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

NIC - ST GEORGE, LLC

Practice address

437 S Bluff St Ste 102
St George, UT 84770-3553

Phone

(435) 635-3727

Fax

(435) 429-0288

NPI assigned

Apr 28, 2020

Organization subpart

No

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

Authorized official

Name

Alex Swanson

Title

Ceo

Phone

(801) 510-9145

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1588032000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1595548800000",
    "number": "1821619107",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "437 S BLUFF ST STE 102",
            "city": "ST GEORGE",
            "state": "UT",
            "postal_code": "847703553",
            "telephone_number": "435-635-3727"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "437 S BLUFF ST STE 102",
            "city": "ST GEORGE",
            "state": "UT",
            "postal_code": "847703553",
            "telephone_number": "435-635-3727",
            "fax_number": "435-429-0288"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NIC - ST GEORGE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-04-28",
        "last_updated": "2020-07-24",
        "certification_date": "2020-07-24",
        "status": "A",
        "authorized_official_last_name": "SWANSON",
        "authorized_official_first_name": "ALEX",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "801-510-9145"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2020; 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.