MEDICARE: QUALITY MEDICAL IMAGING OF UTAH, INC.

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	335V00000X	Portable X-ray and/or Other Portable Diagnostic Imaging Supplier

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

General Provider Information

NPI Number	:	1407023625
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	QUALITY MEDICAL IMAGING OF UTAH, INC.

Provider Business Mailing Address
First Line	:	2490 PROFESSIONAL CT
Second Line	:	ST 110
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-0835
Country	:	US
Telephone Number	:	702-839-1133
Fax Number	:	702-851-1616

Provider Business Practice Location Address
First Line	:	1564 N OVERLAND TRAILS DR
Second Line	:
City	:	WASHINGTON
State	:	UT
Zip	:	84780-2417
Country	:	US
Telephone Number	:	702-839-1133
Fax Number	:	702-851-1616

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. ROGER CARL FASELT
Credential	:
Telephone Number	:	702-839-1133

Provider Enumeration Date	:	05/15/2008
Last Update Date	:	10/25/2021

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