| Desert Edge Medical | |
|
1664 S Dixie Dr Ste D201 St George UT 84770 | |
| (435) 656-2995 | |
| Not Available |
| Full Name | Desert Edge Medical |
|---|---|
| Speciality | Clinic/Center |
| Location | 1664 S Dixie Dr Ste D201, St George, Utah |
| Authorized Official Name and Position | Ryan T Borrowman (OWNER) |
| Authorized Official Contact | 4356562995 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Desert Edge Medical 93 W Orchard Ln Washington UT 84780-2072 Ph: (435) 862-5925 | Desert Edge Medical 1664 S Dixie Dr Ste D201 St George UT 84770 Ph: (435) 656-2995 |
| NPI Number | 1588162911 |
|---|---|
| Provider Enumeration Date | 01/31/2018 |
| Last Update Date | 03/28/2019 |
| Medicare PECOS PAC ID | 2961742051 |
|---|---|
| Medicare Enrollment ID | O20190328000270 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588162911 | NPI | - | NPPES |
| 1487001442 | Medicaid | UT |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
| 261QP2300X | Clinic/center - Primary Care | (Utah) | Primary |
| Provider Name | Diana Grazulis |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1124055710 PECOS PAC ID: 1658275425 Enrollment ID: I20040818000321 |
| Provider Name | Melissa J Hinton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1043545536 PECOS PAC ID: 2062557440 Enrollment ID: I20100310000404 |
| Provider Name | Ryan T Borrowman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1487001442 PECOS PAC ID: 6608154299 Enrollment ID: I20161102001982 |
| Provider Name | Staycha Lee |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1346817061 PECOS PAC ID: 5597165241 Enrollment ID: I20210617000011 |
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