Provider Demographics
NPI:1669142790
Name:ENHANCED DIAGNOSTICS
Entity type:Organization
Organization Name:ENHANCED DIAGNOSTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:B
Authorized Official - Last Name:COWLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:385-492-4064
Mailing Address - Street 1:PO BOX 150524
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84415-0524
Mailing Address - Country:US
Mailing Address - Phone:385-492-4064
Mailing Address - Fax:801-823-0779
Practice Address - Street 1:5504 HOLLY CT
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-5153
Practice Address - Country:US
Practice Address - Phone:385-492-4064
Practice Address - Fax:801-689-3277
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-20
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Single Specialty