Provider Demographics
NPI:1841016672
Name:WASATCH MEDICAL IMAGING LLC
Entity type:Organization
Organization Name:WASATCH MEDICAL IMAGING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:K
Authorized Official - Last Name:ASHBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-964-7813
Mailing Address - Street 1:1776 NORTH HIGHWAY 40
Mailing Address - Street 2:SUITE 103
Mailing Address - City:HEBER
Mailing Address - State:UT
Mailing Address - Zip Code:84032-4148
Mailing Address - Country:US
Mailing Address - Phone:719-650-4347
Mailing Address - Fax:801-692-1873
Practice Address - Street 1:1776 NORTH HIGHWAY 40
Practice Address - Street 2:SUITE 103
Practice Address - City:HEBER
Practice Address - State:UT
Practice Address - Zip Code:84032-4148
Practice Address - Country:US
Practice Address - Phone:719-650-4347
Practice Address - Fax:801-692-1873
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-26
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology