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NPI Code Detail

MEDICARE: MOUNTAIN VALLEY IMAGING OF EASTERN UTAH LLC

MEDICARE: MOUNTAIN VALLEY IMAGING OF EASTERN UTAH LLC
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
12085D0003XDiagnostic Neuroimaging (Radiology) Physician3154161205UT

General Provider Information

NPI Number : 1346441946
Entity Type Code : Organization
Provider Name (Legal Business Name) : MOUNTAIN VALLEY IMAGING OF EASTERN UTAH LLC
Provider Business Mailing Address
First Line : PO BOX 95970
Second Line :
City : SOUTH JORDAN
State : UT
Zip : 84095-0970
Country : US
Telephone Number : 800-877-7081
Fax Number : 801-352-9502
Provider Business Practice Location Address
First Line : 150 W 100 N
Second Line :
City : VERNAL
State : UT
Zip : 84078-2036
Country : US
Telephone Number : 435-789-3342
Fax Number :
Authorized Official
Title or Position : BILLING MANAGER
Name : JEN HOLDAWAY
Credential :
Telephone Number : 801-916-3029
Provider Enumeration Date : 05/30/2007
Last Update Date : 12/02/2024

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Directions to “MOUNTAIN VALLEY IMAGING OF EASTERN UTAH LLC ” Practice Location

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