NPI 1205554367

Tellica Imaging, LLC

Organisation Physiological Laboratory Bountiful, UT

Practice location

Address: 110 N Main St, Bountiful, UT 84010-6134
Phone: (801) 442-5737
Mailing address: 36 S State St, Salt Lake City, UT 84111-1401

Authorised official

Name: Nannette Mignon Berensen
Title: Ceo
Phone: (801) 507-8002

Registered specialties (2)

Physiological Laboratory Primary

Laboratories Taxonomy 293D00000X

Other Physiological Laboratory providers in Utah →

Radiology Clinic/Center

Ambulatory Health Care Facilities Taxonomy 261QR0200X

Other Clinic/Center providers in Utah →

Registry record

NPI: 1205554367
Entity type: Organization
NPI issued: 16 Aug 2022
Record last updated: 7 Feb 2023

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.