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Organization
TELLICA IMAGING, LLC
Active
Organization
TELLICA IMAGING, LLC
Active
Parent organization
INTERMOUNTAIN HEALTHCARE
Organization subpart
Yes
Provider details
NPI number
Legal business name
INTERMOUNTAIN HEALTHCARE
Authorized official
NANNETTE MIGNON BERENSEN (CEO)
(801) 507-8002
Entity
Organization
Contact information
Practice address
110 N MAIN ST, BOUNTIFUL, UT 84010-6134
(801) 442-5737
Mailing address
36 S STATE ST, SALT LAKE CITY, UT 84111-1401
Taxonomy
Speciality
Code
Description
License number
State
261QR0200X
Radiology Clinic/Center
—
—
293D00000X
Physiological Laboratory
Primary
—
—
Other
Enumeration date
08/16/2022
Last updated
02/07/2023
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