Healthcare Provider Details

I. General information

NPI: 1366512808
Provider Name (Legal Business Name): ST GEORGE IMAGING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1490 E FOREMASTER DR BLDG C
SAINT GEORGE UT
84790-4550
US

IV. Provider business mailing address

415 PIMLICO DR
SAINT GEORGE UT
84790-7435
US

V. Phone/Fax

Practice location:
  • Phone: 435-986-2238
  • Fax:
Mailing address:
  • Phone: 435-986-9369
  • Fax: 435-986-9368

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JAMES M DAVIS
Title or Position: MEMBER
Credential:
Phone: 435-986-9369