1346441946 NPI number — MOUNTAIN VALLEY IMAGING OF EASTERN UTAH LLC

Table of content: (NPI 1346441946)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346441946 NPI number — MOUNTAIN VALLEY IMAGING OF EASTERN UTAH LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MOUNTAIN VALLEY IMAGING OF EASTERN UTAH LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1346441946
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/02/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 95970
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOUTH JORDAN
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84095-0970
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-877-7081
Provider Business Mailing Address Fax Number:
801-352-9502

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
150 W 100 N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VERNAL
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84078-2036
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
435-789-3342
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/30/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HOLDAWAY
Authorized Official First Name:
JEN
Authorized Official Middle Name:
Authorized Official Title or Position:
BILLING MANAGER
Authorized Official Telephone Number:
801-916-3029

Provider Taxonomy Codes

  • Taxonomy code: 2085D0003X , with the licence number:  3154161205 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com