Healthcare Provider Details

I. General information

NPI: 1275624587
Provider Name (Legal Business Name): CORAL DESERT IMAGING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1490 E FOREMASTER DR BUILDING C
SAINT GEORGE UT
84790-4488
US

IV. Provider business mailing address

1490 E FOREMASTER DR BUILDING C
SAINT GEORGE UT
84790-4488
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number8437
License Number StateUT

VIII. Authorized Official

Name: MRS. KIMBERLY MCCARTHY
Title or Position: BUSINESS OFFICE MANAGER
Credential:
Phone: 435-986-2238