Provider Demographics
NPI:1265483598
Name:UTAH VALLEY RADIOLOGY ASSOCIATES INC
Entity Type:Organization
Organization Name:UTAH VALLEY RADIOLOGY ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN, PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KIMBALL
Authorized Official - Middle Name:B
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-225-6246
Mailing Address - Street 1:PO BOX 1623
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47706-0025
Mailing Address - Country:US
Mailing Address - Phone:801-379-6700
Mailing Address - Fax:801-225-1525
Practice Address - Street 1:1055 N 300 W STE 104
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-3381
Practice Address - Country:US
Practice Address - Phone:801-379-6700
Practice Address - Fax:801-225-1525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT87028448008Medicaid