# ADVANCED FAMILY MEDICINE, LLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** ADVANCED FAMILY MEDICINE, LLC
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1639546377
- **Legal business name:** ADVANCED FAMILY MEDICINE, LLC
- **Authorized official:** ROGER A RUSSELL DC (CLINIC ADMINISTRATOR)
- **Authorized official phone:** (435) 656-0234

## Contact information

- **Practice address:** 619 S BLUFF ST, TOWER 1 SUITE 100, ST GEORGE, UT 84770-3853
- **Practice address phone:** (435) 656-0234
- **Practice address fax:** (435) 656-2622
- **Mailing address:** 619 S BLUFF ST, TOWER 1 SUITE 100, ST GEORGE, UT 84770-3853
- **Mailing address phone:** (435) 656-0234
- **Mailing address fax:** (435) 656-2622

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 08/28/2015
- **Last updated:** 08/28/2015