Organization
TELLICA IMAGING, LLC
Active
Parent organization
INTERMOUNTAIN HEALTHCARE
Organization subpart
Yes
Provider details
NPI number
Legal business name
INTERMOUNTAIN HEALTHCARE
Authorized official
NANNETTE MIGNON BERENSEN (CEO)
(801) 507-8002
Entity
Organization
Contact information
Practice address
110 N MAIN ST, BOUNTIFUL, UT 84010-6134
(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
08/16/2022
Last updated
02/07/2023
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