Provider Demographics
NPI:1811604630
Name:VANZO-KOCH ENTERPRISES, LLC
Entity type:Organization
Organization Name:VANZO-KOCH ENTERPRISES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CO-FOUNDER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:RENA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:VANZO
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LCGC, MBA
Authorized Official - Phone:217-313-0746
Mailing Address - Street 1:10927 S WOOD STONE CIR
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-8273
Mailing Address - Country:US
Mailing Address - Phone:217-313-0746
Mailing Address - Fax:801-453-6815
Practice Address - Street 1:10927 S WOOD STONE CIR
Practice Address - Street 2:
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095-8273
Practice Address - Country:US
Practice Address - Phone:217-313-0746
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-01
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0207XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile Mammography
No261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile