Organization
TELLICA IMAGING, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRAD ISAACSON (PRESIDENT)
(151) 872-7734
Entity
Organization
Contact information
Practice address
692 EAST MARKET PLACE DRIVE, SPANISH FORK, UT 84660
(610) 772-7252
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
03/22/2024
Last updated
08/27/2025
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