MEDICARE: WEST VALLEY 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	2085R0202X	Diagnostic Radiology Physician

General Provider Information

NPI Number	:	1013231612
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WEST VALLEY IMAGING LLC

Provider Business Mailing Address
First Line	:	3715 WEST 4100 SOUTH
Second Line	:	SUITE 150
City	:	WEST VALLEY CITY
State	:	UT
Zip	:	84120-5537
Country	:	US
Telephone Number	:	801-924-0029
Fax Number	:	801-924-0034

Provider Business Practice Location Address
First Line	:	3715 WEST 4100 SOUTH
Second Line	:	SUITE 150
City	:	WEST VALLEY CITY
State	:	UT
Zip	:	84120-5537
Country	:	US
Telephone Number	:	801-924-0029
Fax Number	:	801-924-0034

Authorized Official
Title or Position	:	ANALYST
Name	:	MR. LAVELLE R HARDIN
Credential	:
Telephone Number	:	615-344-8203

Provider Enumeration Date	:	03/25/2010
Last Update Date	:	10/04/2011

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