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General NPI Number Information
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NPI Number | 1487643904
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Entity Type | Organization
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Legal Business Name | NORTHERN UTAH IMAGING LLC
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Dates
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Enumeration Date | 10/18/2005
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Last Update Date | 11/08/2010
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Provider Practice Location Address
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Address Line | 3738 S 900 E
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City | SALT LAKE CITY
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State | UT
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Zip | 84106-1913
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Country | US
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Telephone | 801-313-1955
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Fax | 801-313-1965
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Provider Business Mailing Address
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Address Line | 3738 S 900 E
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City | SALT LAKE CITY
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State | UT
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Zip | 84106-1913
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Country | US
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Telephone | 801-313-1955
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Fax | 801-313-1965
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Authorized Official
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Title or Position | IMAGING & ONCOLOGY MANAGED CARE
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Name | MR. LAVELLE HARDIN
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Credential |
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Telephone | 615-372-5441
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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