Provider Demographics
NPI:1184758989
Name:SOUTH VALLEY WOMEN'S IMAGING, LLC
Entity type:Organization
Organization Name:SOUTH VALLEY WOMEN'S IMAGING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUS OFC SUPR
Authorized Official - Prefix:
Authorized Official - First Name:PAM
Authorized Official - Middle Name:
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-569-5328
Mailing Address - Street 1:3570 W 9000 S STE 210
Mailing Address - Street 2:
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84088-8876
Mailing Address - Country:US
Mailing Address - Phone:801-569-2626
Mailing Address - Fax:801-596-5333
Practice Address - Street 1:3570 W 9000 S
Practice Address - Street 2:#130
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84088-8869
Practice Address - Country:US
Practice Address - Phone:801-569-2626
Practice Address - Fax:801-569-5333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty