Healthcare Provider Details

I. General information

NPI: 1518871979
Provider Name (Legal Business Name): ST. GEORGE GASTROENTEROLOGY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

652 S MEDICAL CENTER DR STE 210
ST GEORGE UT
84790-7049
US

IV. Provider business mailing address

340 SEVEN SPRINGS WAY STE 600
BRENTWOOD TN
37027-5605
US

V. Phone/Fax

Practice location:
  • Phone: 615-234-5954
  • Fax:
Mailing address:
  • Phone: 615-234-5954
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name: JENNIFER BALDOCK
Title or Position: OFFICER AND AUTHORIZED OFFICIAL
Credential:
Phone: 615-234-5954