Healthcare Provider Details

I. General information

NPI: 1790736130
Provider Name (Legal Business Name): ST. GEORGE RADIOLOGY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 09/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1308 E 900 S
ST GEORGE UT
84790-8520
US

IV. Provider business mailing address

1308 E 900 S
ST GEORGE UT
84790-8520
US

V. Phone/Fax

Practice location:
  • Phone: 435-673-2301
  • Fax: 435-673-2336
Mailing address:
  • Phone: 435-673-2301
  • Fax: 435-673-2336

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: BLAKE W. ARNOLD
Title or Position: MANAGING PARTNER
Credential: MD
Phone: 356-686-2384