| Organization Name: | SNOW CANYON CLINIC, INC. |
| NPI Number: | 1235185646 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | REBECCA JOHNSON (CEO) |
| Mailing Address: | 272 E Center St Ivins |
| State: | UT US |
| Postal Code: | 847386456 |
| Phone Number: | 4359862300 |
| Fax Number: | 4359862323 |
| NPI Enumeration Date: | 05/26/2006 |
| NPI Last Update Date: | 10/30/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QM1300X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Multi-Specialty |
| Taxonomy Definition: | |