Healthcare Provider Details

I. General information

NPI: 1699004499
Provider Name (Legal Business Name): TOOELE VALLEY IMAGING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2009
Last Update Date: 02/15/2023
Certification Date: 02/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2356 N 400 E SUITE 103
TOOELE UT
84074-3409
US

IV. Provider business mailing address

PO BOX 30015 DEPT 73
SALT LAKE CITY UT
84130-0015
US

V. Phone/Fax

Practice location:
  • Phone: 435-882-1674
  • Fax: 435-882-1822
Mailing address:
  • Phone: 435-882-1674
  • Fax: 435-882-1822

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Clinic/Center
License Number
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number
License Number StateUT

VIII. Authorized Official

Name: MR. DAVID M CARTER
Title or Position: MANAGING MEMBER
Credential:
Phone: 435-882-1674