MEDICARE: NORTHERN UTAH HEALTHCARE CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR0200X	Radiology Clinic/Center

General Provider Information

NPI Number	:	1013849389
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHERN UTAH HEALTHCARE CORPORATION

Provider Business Mailing Address
First Line	:	3738 S 900 E
Second Line	:
City	:	MILLCREEK
State	:	UT
Zip	:	84106-1913
Country	:	US
Telephone Number	:	801-313-1955
Fax Number	:

Provider Business Practice Location Address
First Line	:	3738 S 900 E
Second Line	:
City	:	MILLCREEK
State	:	UT
Zip	:	84106-1913
Country	:	US
Telephone Number	:	801-313-1955
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	BRADEN TIBBITTS
Credential	:
Telephone Number	:	801-465-7107

Provider Enumeration Date	:	06/01/2026
Last Update Date	:	06/01/2026

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Directions to “NORTHERN UTAH HEALTHCARE CORPORATION ” Practice Location

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