Healthcare Provider Details

I. General information

NPI: 1306153226
Provider Name (Legal Business Name): IMAGING SOLUTIONS OF SOUTHERN UTAH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2010
Last Update Date: 09/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

968 E HIGH NOON CIR
WASHINGTON UT
84780-8324
US

IV. Provider business mailing address

968 E HIGH NOON CIR
WASHINGTON UT
84780-8324
US

V. Phone/Fax

Practice location:
  • Phone: 435-668-6511
  • Fax:
Mailing address:
  • Phone: 435-668-6511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0208X
TaxonomyMobile Radiology Clinic/Center
License Number380990-5401
License Number StateUT

VIII. Authorized Official

Name: MICHAEL T GOLDER
Title or Position: MANAGING MEMBER
Credential: RT, R (MR)
Phone: 435-668-6511