Basic Information
| Provider Information | |||||||||
| NPI: | 1750704532 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NOTUS IMAGING AND RESEARCH LABORATORIES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 560 W 800 N | ||||||||
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| City: | OREM | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840573746 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8012256246 | ||||||||
| FaxNumber: | 8012251525 | ||||||||
| Practice Location | |||||||||
| Address1: | 280 RIVER PARK DR | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | PROVO | ||||||||
| State: | UT | ||||||||
| PostalCode: | 846045764 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8012256246 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/29/2014 | ||||||||
| LastUpdateDate: | 01/29/2014 | ||||||||
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| AuthorizedOfficialLastName: | BURGON | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 8017016507 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No ID Information.