# TELLICA IMAGING, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1518727734
- **Authorized official:** BRAD ISAACSON (PRESIDENT)
- **Authorized official phone:** (151) 872-7734

## Contact information

- **Practice address:** 692 EAST MARKET PLACE DRIVE, SPANISH FORK, UT 84660
- **Practice address phone:** (610) 772-7252
- **Mailing address:** 36 S STATE ST, SALT LAKE CITY, UT 84111-1401

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QR0200X | Radiology Clinic/Center | — | NULL | — |
| 293D00000X | Physiological Laboratory | — | NULL | Yes |

## Other

- **Enumeration date:** 03/22/2024
- **Last updated:** 08/27/2025