Healthcare Provider Details

I. General information

NPI: 1942978861
Provider Name (Legal Business Name): WASATCH MOBILE IMAGING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2021
Last Update Date: 09/03/2021
Certification Date: 08/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2008 W 1950 S
WOODS CROSS UT
84087-5034
US

IV. Provider business mailing address

90 W 500 S # 338
BOUNTIFUL UT
84010-6230
US

V. Phone/Fax

Practice location:
  • Phone: 801-897-5293
  • Fax:
Mailing address:
  • Phone: 801-897-5293
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0208X
TaxonomyMobile Radiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. KATHRINA GRAN
Title or Position: MANAGER
Credential: RN
Phone: 801-897-5293