Healthcare Provider Details

I. General information

NPI: 1811604630
Provider Name (Legal Business Name): VANZO-KOCH ENTERPRISES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2022
Last Update Date: 02/05/2024
Certification Date: 02/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10927 S WOOD STONE CIR
SOUTH JORDAN UT
84095-8273
US

IV. Provider business mailing address

10927 S WOOD STONE CIR
SOUTH JORDAN UT
84095-8273
US

V. Phone/Fax

Practice location:
  • Phone: 217-313-0746
  • Fax:
Mailing address:
  • Phone: 217-313-0746
  • Fax: 801-453-6815

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0208X
TaxonomyMobile Radiology Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR0207X
TaxonomyMobile Mammography Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RENA JEAN VANZO
Title or Position: CO-FOUNDER/CEO
Credential: MS, LCGC, MBA
Phone: 217-313-0746