Healthcare Provider Details

I. General information

NPI: 1194518688
Provider Name (Legal Business Name): PMDUT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2025
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1288 W 2240 S STE B-1
WEST VALLEY UT
84119-1404
US

IV. Provider business mailing address

1600 W BROADWAY RD STE 155
TEMPE AZ
85282-1138
US

V. Phone/Fax

Practice location:
  • Phone: 801-503-0500
  • Fax:
Mailing address:
  • Phone: 801-503-0500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335V00000X
TaxonomyPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
License Number
License Number State

VIII. Authorized Official

Name: TANGINA R MALOOF
Title or Position: TREASURER
Credential:
Phone: 469-636-5055