Basic Information
| Provider Information | |||||||||
| NPI: | 1114140027 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MOUNTAIN VALLEY IMAGING OF UTAH | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | PARK CITY IMAGING | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2910 WASHINGTON BLVD | ||||||||
| Address2: | SUITE 310 | ||||||||
| City: | OGDEN | ||||||||
| State: | UT | ||||||||
| PostalCode: | 844013751 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8016216671 | ||||||||
| FaxNumber: | 8016276679 | ||||||||
| Practice Location | |||||||||
| Address1: | 1850 SIDEWINDER DR | ||||||||
| Address2: | #410 | ||||||||
| City: | PARK CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840607471 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4356150250 | ||||||||
| FaxNumber: | 4356150252 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/10/2007 | ||||||||
| LastUpdateDate: | 03/25/2008 | ||||||||
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| AuthorizedOfficialLastName: | OLSON | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
| AuthorizedOfficialMiddleName: | C | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8016216671 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085D0003X | 170278-1205 | UT | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Neuroimaging |
No ID Information.