Provider Demographics
NPI:1386952448
Name:AA PURE HEALTH INC
Entity type:Organization
Organization Name:AA PURE HEALTH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMEREST
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-862-0125
Mailing Address - Street 1:491 E RIVERSIDE DR
Mailing Address - Street 2:SUITE 4B
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-7051
Mailing Address - Country:US
Mailing Address - Phone:435-862-0125
Mailing Address - Fax:
Practice Address - Street 1:491 E RIVERSIDE DR
Practice Address - Street 2:SUITE 4B
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-7051
Practice Address - Country:US
Practice Address - Phone:435-862-0125
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-22
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7285373-1202305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service