Basic Information
| Provider Information | |||||||||
| NPI: | 1235188608 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DIAGNOSTIC HEALTH CORPORATION | ||||||||
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| OtherOrganizationName: | HEALTHSOUTH DIAGNOSTIC CENTER OF PARK CITY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1850 SIDEWINDER DR | ||||||||
| Address2: | SUITE 410 | ||||||||
| City: | PARK CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840607471 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4356150250 | ||||||||
| FaxNumber: | 4356150252 | ||||||||
| Practice Location | |||||||||
| Address1: | 1850 SIDEWINDER DR | ||||||||
| Address2: | SUITE 410 | ||||||||
| City: | PARK CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840607471 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4356150250 | ||||||||
| FaxNumber: | 4356150252 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/10/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | BURCH | ||||||||
| AuthorizedOfficialFirstName: | DONNA | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | CREDENTIALING SPECIALIST | ||||||||
| AuthorizedOfficialTelephone: | 8666855001 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 293D00000X | Y | Laboratories | Physiological Laboratory |
No ID Information.