MEDICARE: DESERT PEAK IMAGING, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM1200X	Magnetic Resonance Imaging (MRI) Clinic/Center

General Provider Information

NPI Number	:	1104499755
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DESERT PEAK IMAGING, LLC

Provider Business Mailing Address
First Line	:	380 E MAIN ST STE B
Second Line	:
City	:	MIDWAY
State	:	UT
Zip	:	84049-6802
Country	:	US
Telephone Number	:	435-627-5390
Fax Number	:

Provider Business Practice Location Address
First Line	:	1490 E FOREMASTER DR BLDG C
Second Line	:
City	:	ST GEORGE
State	:	UT
Zip	:	84790-4550
Country	:	US
Telephone Number	:	435-627-5390
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. DAVID HEYWOOD
Credential	:
Telephone Number	:	435-627-5390

Provider Enumeration Date	:	07/21/2021
Last Update Date	:	10/12/2022

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