Healthcare Provider Details

I. General information

NPI: 1689399529
Provider Name (Legal Business Name): ACTA HOLDINGS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2022
Last Update Date: 10/06/2022
Certification Date: 10/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3535 S MARKET ST STE 200
WEST VALLEY CITY UT
84119-3617
US

IV. Provider business mailing address

3535 S MARKET ST STE 200
WEST VALLEY CITY UT
84119-3617
US

V. Phone/Fax

Practice location:
  • Phone: 801-871-8937
  • Fax:
Mailing address:
  • Phone: 801-871-8937
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: EDWARD CALLAHAN III
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: MD
Phone: 509-679-2668