Provider Demographics
NPI:1790736130
Name:ST. GEORGE RADIOLOGY INC.
Entity Type:Organization
Organization Name:ST. GEORGE RADIOLOGY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:BLAKE
Authorized Official - Middle Name:W
Authorized Official - Last Name:ARNOLD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:356-686-2384
Mailing Address - Street 1:1308 E 900 S
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-8520
Mailing Address - Country:US
Mailing Address - Phone:435-673-2301
Mailing Address - Fax:435-673-2336
Practice Address - Street 1:1308 E 900 S
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-8520
Practice Address - Country:US
Practice Address - Phone:435-673-2301
Practice Address - Fax:435-673-2336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVNV9414OtherNV GROUP BX #
UT=========004Medicaid
UT=========004Medicaid
UT00524200Medicare ID - Type UnspecifiedGROUP MEDICARE #