Healthcare Provider Details

I. General information

NPI: 1184758989
Provider Name (Legal Business Name): SOUTH VALLEY WOMEN'S IMAGING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3570 W 9000 S #130
WEST JORDAN UT
84088-8869
US

IV. Provider business mailing address

3570 W 9000 S STE 210
WEST JORDAN UT
84088-8876
US

V. Phone/Fax

Practice location:
  • Phone: 801-569-2626
  • Fax: 801-569-5333
Mailing address:
  • Phone: 801-569-2626
  • Fax: 801-596-5333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateUT

VIII. Authorized Official

Name: PAM NELSON
Title or Position: BUS OFC SUPR
Credential:
Phone: 801-569-5328