Basic Information
| Provider Information | |||||||||
| NPI: | 1548443716 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ZOLLINGER | ||||||||
| FirstName: | LAUREN | ||||||||
| MiddleName: | VIRGINIA | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D., M.P.H. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 25488 | ||||||||
| Address2: | |||||||||
| City: | SALT LAKE CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841250488 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8004753698 | ||||||||
| FaxNumber: | 7195912745 | ||||||||
| Practice Location | |||||||||
| Address1: | 1433 N 1075 W STE 104 | ||||||||
| Address2: | |||||||||
| City: | FARMINGTON | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840252746 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8012981300 | ||||||||
| FaxNumber: | 8012966199 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/11/2007 | ||||||||
| LastUpdateDate: | 02/26/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085N0700X | 6020095-1205 | UT | N | Allopathic & Osteopathic Physicians | Radiology | Neuroradiology | 2085N0904X | 6020095-1205 | UT | N | Allopathic & Osteopathic Physicians | Radiology | Nuclear Radiology | 2085R0202X | 6020095-1205 | UT | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 1088740 | 01 | UT | DMBA | OTHER | 9934921 | 01 | UT | AETNA HEALTHCARE | OTHER | 1548443716 | 01 | UT | EMI HEALTH | OTHER | 1548443716 | 01 | UT | MOLINA HEALTHCARE | OTHER | 10000010000001 | 01 | UT | BCBSU | OTHER | 145449 | 01 | UT | PEHP | OTHER | 1548443716 | 05 | UT | MEDICAID | 107083502104 | 01 | UT | SELECTHEALTH | OTHER | P01180706 | 01 | UT | RAILROAD MEDICARE | OTHER |