Organization
CORAL DESERT SURGERY CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAN NIELSON (ADMINISTRATOR)
(435) 674-5230
Entity
Organization
Contact information
Practice address
1490 E FOREMASTER DR, BUILDING C, ST GEORGE, UT 84790-4488
(435) 674-5230
(435) 674-5231
Mailing address
1490 E FOREMASTER DR, BUILDING C, ST GEORGE, UT 84790-4488
(435) 674-5230
(435) 674-5231
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
2005-ASF-52092
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
838112
—
AZ
01
—
P00085628
RAILROAD MEDICARE
UT
Enumeration date
04/17/2006
Last updated
06/09/2017
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