MEDICARE: UTAH IMAGING CENTERS 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
1	2471M1202X	Magnetic Resonance Imaging Radiologic Technologist	T1325	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

General Provider Information

NPI Number	:	1598763294
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UTAH IMAGING CENTERS LLC

Provider Business Mailing Address
First Line	:	PO BOX 1288
Second Line	:
City	:	BOUNTIFUL
State	:	UT
Zip	:	84011-1288
Country	:	US
Telephone Number	:	801-296-2413
Fax Number	:	801-296-1715

Provider Business Practice Location Address
First Line	:	3715 W 4100 S
Second Line	:	STE 150
City	:	WEST VALLEY CITY
State	:	UT
Zip	:	84120-5552
Country	:	US
Telephone Number	:	801-924-0029
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	BRETT PALMER
Credential	:
Telephone Number	:	801-298-1300

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	03/25/2010

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