Healthcare Provider Details

I. General information

NPI: 1790549152
Provider Name (Legal Business Name): MEDICAL MOBILE IMAGING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2024
Last Update Date: 02/13/2024
Certification Date: 02/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

972 CHAMBERS ST STE 7
SOUTH OGDEN UT
84403-4873
US

IV. Provider business mailing address

972 CHAMBERS ST STE 7
SOUTH OGDEN UT
84403-4873
US

V. Phone/Fax

Practice location:
  • Phone: 801-710-9023
  • Fax:
Mailing address:
  • Phone: 801-710-9023
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0208X
TaxonomyMobile Radiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TANYA JENSEN
Title or Position: BUSINESS OWNER
Credential: RT(R)(CT)
Phone: 801-710-9023