Provider Demographics
NPI:1689399529
Name:ACTA HOLDINGS LLC
Entity Type:Organization
Organization Name:ACTA HOLDINGS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:CALLAHAN
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:509-679-2668
Mailing Address - Street 1:3535 S MARKET ST STE 200
Mailing Address - Street 2:
Mailing Address - City:WEST VALLEY CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84119-3617
Mailing Address - Country:US
Mailing Address - Phone:801-871-8937
Mailing Address - Fax:
Practice Address - Street 1:3535 S MARKET ST STE 200
Practice Address - Street 2:
Practice Address - City:WEST VALLEY CITY
Practice Address - State:UT
Practice Address - Zip Code:84119-3617
Practice Address - Country:US
Practice Address - Phone:801-871-8937
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-04
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)