Organization
TELLICA IMAGING, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRAD ISAACSON (PRESIDENT)
(801) 442-5737
Entity
Organization
Contact information
Practice address
100 N MARIO CAPECCHI DR, SALT LAKE CITY, UT 84113-1103
(208) 417-5100
Mailing address
36 S STATE ST, SALT LAKE CITY, UT 84111-1401
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
—
—
261QR0200X
Radiology Clinic/Center
Primary
—
—
Other
Enumeration date
06/19/2024
Last updated
06/19/2024
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