Blake Mortenson (NPI# 1427056860, PAC ID# 4981508009) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is DIAGNOSTIC RADIOLOGY.
| Nation Provider ID (NPI) | 1427056860 |
| PAC ID by PECOS | 4981508009 |
| Professional Enrollment ID | I20031120000932 |
| Full Name | Blake Mortenson |
| Organization Legal Name | LOGAN RADIOLOGY GROUP LLC |
| Address |
44 N 1st Preston ID 83263-1326 |
| Phone Number | 2088520137 |
| Gender | M |
| Credential | MD |
| Medical School | UNIVERSITY OF UTAH SCHOOL OF MEDICINE |
| Graduation Year | 1992 |
| Primary Specialty | DIAGNOSTIC RADIOLOGY |
| Group Practice PAC ID | 5496669152 |
| Number of Group Practice Members | 8 |
| Accepts Medicare Assignment | Y |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 460015 | LOGAN REGIONAL HOSPITAL |
| 460039 | BEAR RIVER VALLEY HOSPITAL |
| 460054 | CACHE VALLEY HOSPITAL |
| Address | Phone | Organization |
|---|---|---|
| 1400 N 500, Logan, UT 84341-2455 | 8016737661 | LOGAN RADIOLOGY GROUP LLC |
| 44 N 1st, Preston, ID 83263-1326 | 2088520137 | LOGAN RADIOLOGY GROUP LLC |
| 1380 E Medical Ctr Dr, Drmc Critical Care Pulm, St George, UT 84770-2122 | 4352512355 | IHC HEALTH SERVICES INC |
| 1380 E Medical Ctr Dr, St George, UT 84790-2123 | IHC HEALTH SERVICES INC |
| Organization Legal Name | LOGAN RADIOLOGY GROUP LLC |
| Physicians | 2 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Jeffrey Job | Diagnostic Radiology | Logan Radiology Group LLC | 44 N 1st, Preston, ID 83263-1326 |
| Street Address |
44 N 1ST |
| City | PRESTON |
| State | ID |
| Zip | 83263-1326 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Avery A Jeffers | Internal Medicine | Franklin County Medical Center | 44 N 1st, Preston, ID 83263-1326 |
| Jeffrey Job | Diagnostic Radiology | Logan Radiology Group LLC | 44 N 1st, Preston, ID 83263-1326 |
| Chelsie A Morrison | Family Medicine | Franklin County Medical Center | 44 N 1st, Preston, ID 83263-1326 |
| Hannah Beate Thomsen | Nurse Practitioner | Alpine Management and Consulting LLC | 44 N 1st, Preston, ID 83263-1326 |
| Joel T Webb | Physician Assistant | Franklin County Medical Center | 44 N 1st, Preston, ID 83263-1326 |
| Chantee Isabel Wyatt | Physician Assistant | Franklin County Medical Center | 44 N 1st, Preston, ID 83263-1326 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Leonard E Ward | Chiropractic | 122 N State St, Preston, ID 83263-1143 | |
| Lance D Henderson | Optometry | Eye Care for You LLC | 134 N State St, Suite A, Preston, ID 83263-1143 |
| Philip G Cromwell | Optometry | Eye Care for You LLC | 134 N State St, Suite A, Preston, ID 83263-1143 |
| Jeffrey L Cromwell | Optometry | Eye Care for You LLC | 134 N State St, Suite A, Preston, ID 83263-1143 |
| David R Priestley | Clinical Social Worker | Priestley Mental Health, Inc | 75 S 1st, Preston, ID 83263-1204 |
| Cami D Fellows | Clinical Social Worker | Priestley Mental Health, Inc | 75 S 1st, Preston, ID 83263-1204 |
| Karen H Hull | Clinical Social Worker | Priestley Mental Health, Inc | 75 S 1st, Preston, ID 83263-1204 |
| Rand M Jensen | Clinical Social Worker | Priestley Mental Health, Inc | 75 S 1st, Preston, ID 83263-1204 |
| Douglas Scott Fellows | Chiropractic | 8 S State St, Preston, ID 83263-1243 | |
| Tifani J Waechtler | Physical Therapy | Preston Physical Therapy LLC | 10 S 100, Suite A, Preston, ID 83263-1244 |
| Find all physicians in zip 83263 | |||
| City | PRESTON |
| Zip Code | 83263 |
| Specialty | DIAGNOSTIC RADIOLOGY |
| City + Specialty | PRESTON + DIAGNOSTIC RADIOLOGY |
Please comment or provide details below to improve the information on Blake Mortenson.
| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.