MEDICARE: ST GEORGE 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	:	1366512808
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST GEORGE IMAGING LLC

Provider Business Mailing Address
First Line	:	415 PIMLICO DR
Second Line	:
City	:	SAINT GEORGE
State	:	UT
Zip	:	84790-7435
Country	:	US
Telephone Number	:	435-986-9369
Fax Number	:	435-986-9368

Provider Business Practice Location Address
First Line	:	1490 E FOREMASTER DR BLDG C
Second Line	:
City	:	SAINT GEORGE
State	:	UT
Zip	:	84790-4550
Country	:	US
Telephone Number	:	435-986-2238
Fax Number	:

Authorized Official
Title or Position	:	MEMBER
Name	:	JAMES M DAVIS
Credential	:
Telephone Number	:	435-986-9369

Provider Enumeration Date	:	11/09/2006
Last Update Date	:	08/22/2020

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