Organization
TELLICA IMAGING, LLC
Active
Parent organization
INTERMOUNTAIN HEALTHCARE
Organization subpart
Yes
Provider details
NPI number
Legal business name
INTERMOUNTAIN HEALTHCARE
Authorized official
BRAD ISAACSON PHD (PRESIDENT)
(801) 442-5737
Entity
Organization
Contact information
Practice address
1028 CHAMBERS ST, OGDEN, UT 84403-5181
(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
04/22/2021
Last updated
03/22/2024
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