Provider Demographics
NPI:1316650666
Name:KNEE REGENERATION AND ADVANCED HEALTHCARE OF ST GEORGE
Entity type:Organization
Organization Name:KNEE REGENERATION AND ADVANCED HEALTHCARE OF ST GEORGE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINIC OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TIM
Authorized Official - Middle Name:
Authorized Official - Last Name:SHINKLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-607-0407
Mailing Address - Street 1:640 E 700 S STE 206
Mailing Address - Street 2:
Mailing Address - City:SAINT GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-5732
Mailing Address - Country:US
Mailing Address - Phone:928-607-0407
Mailing Address - Fax:
Practice Address - Street 1:640 E 700 S STE 206
Practice Address - Street 2:
Practice Address - City:SAINT GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-5732
Practice Address - Country:US
Practice Address - Phone:928-607-0407
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KNEE REGENERATION AND ADVANCED HEALTHCARE OF ST GEORGE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-01-03
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty