| Desert Ridge Neurology | |
|
295 S 1470 E Ste 301 St George UT 84790-1762 | |
| (435) 775-2015 | |
| (435) 775-2016 |
| Full Name | Desert Ridge Neurology |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 295 S 1470 E Ste 301, St George, Utah |
| Authorized Official Name and Position | Trenton L Overall (PRESIDENT) |
| Authorized Official Contact | 4352186958 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Desert Ridge Neurology 295 S 1470 E Ste 301 Saint George UT 84790-1762 Ph: () - | Desert Ridge Neurology 295 S 1470 E Ste 301 St George UT 84790-1762 Ph: (435) 775-2015 |
| NPI Number | 1922607589 |
|---|---|
| Provider Enumeration Date | 10/23/2020 |
| Last Update Date | 11/20/2020 |
| Certification Date | 11/20/2020 |
| Medicare PECOS PAC ID | 6507279197 |
|---|---|
| Medicare Enrollment ID | O20201228000726 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922607589 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | (* (Not Available)) | Primary |
| Provider Name | Trenton Lee Overall |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1841575032 PECOS PAC ID: 2062658826 Enrollment ID: I20150625002334 |
| Provider Name | Kelsie A Montgomery |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1437672326 PECOS PAC ID: 3971863994 Enrollment ID: I20180212001155 |
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