Healthcare Provider Details

I. General information

NPI: 1346441946
Provider Name (Legal Business Name): MOUNTAIN VALLEY IMAGING OF EASTERN UTAH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2007
Last Update Date: 12/02/2024
Certification Date: 11/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 W 100 N
VERNAL UT
84078-2036
US

IV. Provider business mailing address

PO BOX 95970
SOUTH JORDAN UT
84095-0970
US

V. Phone/Fax

Practice location:
  • Phone: 435-789-3342
  • Fax:
Mailing address:
  • Phone: 800-877-7081
  • Fax: 801-352-9502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085D0003X
TaxonomyDiagnostic Neuroimaging (Radiology) Physician
License Number3154161205
License Number StateUT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: JEN HOLDAWAY
Title or Position: BILLING MANAGER
Credential:
Phone: 801-916-3029