Provider Demographics
NPI:1114140027
Name:MOUNTAIN VALLEY IMAGING OF UTAH
Entity Type:Organization
Organization Name:MOUNTAIN VALLEY IMAGING OF UTAH
Other - Org Name:PARK CITY IMAGING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:C
Authorized Official - Last Name:OLSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-621-6671
Mailing Address - Street 1:2910 WASHINGTON BLVD
Mailing Address - Street 2:SUITE 310
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84401-3751
Mailing Address - Country:US
Mailing Address - Phone:801-621-6671
Mailing Address - Fax:801-627-6679
Practice Address - Street 1:1850 SIDEWINDER DR
Practice Address - Street 2:#410
Practice Address - City:PARK CITY
Practice Address - State:UT
Practice Address - Zip Code:84060-7471
Practice Address - Country:US
Practice Address - Phone:435-615-0250
Practice Address - Fax:435-615-0252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT170278-12052085D0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085D0003XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic NeuroimagingGroup - Single Specialty