Provider Demographics
NPI:1013231612
Name:WEST VALLEY IMAGING LLC
Entity Type:Organization
Organization Name:WEST VALLEY IMAGING LLC
Other - Org Name:UTAH IMAGING WEST VALLEY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ANALYST
Authorized Official - Prefix:MR
Authorized Official - First Name:LAVELLE
Authorized Official - Middle Name:R
Authorized Official - Last Name:HARDIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-344-8203
Mailing Address - Street 1:3715 WEST 4100 SOUTH
Mailing Address - Street 2:SUITE 150
Mailing Address - City:WEST VALLEY CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84120-5537
Mailing Address - Country:US
Mailing Address - Phone:801-924-0029
Mailing Address - Fax:801-924-0034
Practice Address - Street 1:3715 WEST 4100 SOUTH
Practice Address - Street 2:SUITE 150
Practice Address - City:WEST VALLEY CITY
Practice Address - State:UT
Practice Address - Zip Code:84120-5537
Practice Address - Country:US
Practice Address - Phone:801-924-0029
Practice Address - Fax:801-924-0034
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-25
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000068949Medicare PIN