MEDICARE: HUNTER IMAGING ASSOCIATES, PC

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	2085R0202X	Diagnostic Radiology Physician	5708575	UT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1346240447
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HUNTER IMAGING ASSOCIATES, PC

Provider Business Mailing Address
First Line	:	PO BOX 1169
Second Line	:
City	:	BOUNTIFUL
State	:	UT
Zip	:	84011-1169
Country	:	US
Telephone Number	:	801-296-2113
Fax Number	:	801-296-1715

Provider Business Practice Location Address
First Line	:	3725 W 4100 S
Second Line	:
City	:	WEST VALLEY CITY
State	:	UT
Zip	:	84120-5530
Country	:	US
Telephone Number	:	801-652-4466
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	EDGAR BOOTH
Credential	:
Telephone Number	:	801-652-4466

Provider Enumeration Date	:	07/29/2005
Last Update Date	:	11/28/2018

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