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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
MARK VAWDREY (CHIEF FINANCIAL OFFICER)
(801) 718-1642
Entity
Organization
Contact information
Practice address
1100 BICENTENNIAL DR STE 3B, MANCHESTER, NH 03104-2173
(603) 292-3491
Mailing address
36 S STATE ST STE 2200, SALT LAKE CITY, UT 84111-1470
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
—
—
261QR0200X
Radiology Clinic/Center
Primary
—
—
Other
Enumeration date
03/29/2023
Last updated
08/27/2025
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