Provider Demographics
NPI:1336318666
Name:UTAH VALLEY OBSTETRICAL ULTRA SOUND
Entity Type:Organization
Organization Name:UTAH VALLEY OBSTETRICAL ULTRA SOUND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ULTRASONOGRAPHER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JODIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LAYTON
Authorized Official - Suffix:
Authorized Official - Credentials:RDMS
Authorized Official - Phone:801-357-7377
Mailing Address - Street 1:PO BOX 971388
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84097-1388
Mailing Address - Country:US
Mailing Address - Phone:801-225-5407
Mailing Address - Fax:801-225-5623
Practice Address - Street 1:1055 N 300 W STE 303
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-3373
Practice Address - Country:US
Practice Address - Phone:801-357-7377
Practice Address - Fax:801-765-8805
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-20
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT761012471S1302X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonographyGroup - Single Specialty