Provider Demographics
NPI:1386671196
Name:ST GEORGE SLEEP MEDICINE CENTER PC
Entity type:Organization
Organization Name:ST GEORGE SLEEP MEDICINE CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KIRK
Authorized Official - Middle Name:G
Authorized Official - Last Name:WATKINS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:435-634-9630
Mailing Address - Street 1:251 HILTON DR
Mailing Address - Street 2:#107
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-2320
Mailing Address - Country:US
Mailing Address - Phone:435-634-9630
Mailing Address - Fax:435-634-9622
Practice Address - Street 1:251 HILTON DR
Practice Address - Street 2:# 107
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-2320
Practice Address - Country:US
Practice Address - Phone:435-634-9630
Practice Address - Fax:435-634-9622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-27
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT325420261QS1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT528066321022Medicaid
UT528066321022Medicaid