Provider Demographics
NPI:1598763294
Name:UTAH IMAGING CENTERS LLC
Entity Type:Organization
Organization Name:UTAH IMAGING CENTERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:
Authorized Official - Last Name:PALMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-298-1300
Mailing Address - Street 1:PO BOX 1288
Mailing Address - Street 2:
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84011-1288
Mailing Address - Country:US
Mailing Address - Phone:801-296-2413
Mailing Address - Fax:801-296-1715
Practice Address - Street 1:3715 W 4100 S
Practice Address - Street 2:STE 150
Practice Address - City:WEST VALLEY CITY
Practice Address - State:UT
Practice Address - Zip Code:84120-5552
Practice Address - Country:US
Practice Address - Phone:801-924-0029
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-07
Last Update Date:2010-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UTT13252471M1202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2471M1202XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistMagnetic Resonance ImagingGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID8071213Medicaid
UT=========001Medicaid
UT=========002Medicaid
UT000090747Medicare PIN
UTP00164917Medicare PIN
UTP00077349Medicare PIN
UT000057830Medicare PIN
ID8071213Medicare PIN