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
345 AMHERST ST STE 3, NASHUA, NH 03063-1754
(603) 292-3006
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
04/11/2024
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