Provider Demographics
NPI:1457793697
Name:HUNTSMAN WEST SPINE LLC
Entity type:Organization
Organization Name:HUNTSMAN WEST SPINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER / MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTOFFER
Authorized Official - Middle Name:R
Authorized Official - Last Name:WEST
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:435-652-6024
Mailing Address - Street 1:617 E RIVERSIDE DR STE 302
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-8722
Mailing Address - Country:US
Mailing Address - Phone:435-652-6024
Mailing Address - Fax:435-652-6025
Practice Address - Street 1:230 N 1680 E
Practice Address - Street 2:STE I-1
Practice Address - City:SAINT GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-2579
Practice Address - Country:US
Practice Address - Phone:435-652-6024
Practice Address - Fax:435-652-6025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-29
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8635840-1205207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Single Specialty