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General NPI Number Information
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NPI Number | 1508533878
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Entity Type | Organization
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Legal Business Name | GREEN RIVER RADIOLOGY, P.C.
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Dates
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Enumeration Date | 08/25/2021
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Last Update Date | 08/18/2025
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Provider Practice Location Address
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Address Line | 1982 W PLEASANT GROVE BLVD STE L
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City | PLEASANT GROVE
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State | UT
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Zip | 84062-3268
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Country | US
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Telephone | 801-563-0333
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Fax | 801-563-0335
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Provider Business Mailing Address
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Address Line | 5775 WAYZATA BLVD STE 400
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City | SAINT LOUIS PARK
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State | MN
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Zip | 55416-1271
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Country | US
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Telephone | 866-674-7933
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Fax | 952-513-6880
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Authorized Official
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Title or Position | SPECIAL ASSISTANT SECRETARY
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Name | RAMONA AHERN
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Credential |
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Telephone | 952-738-4441
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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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