Basic Information
| Provider Information | |||||||||
| NPI: | 1972628741 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | INTERMOUNTAIN VIEN CENTER-DRAPER | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | UTAH VALLEY RADIOLOGY ASSOC. INC. | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 283 E 930 S | ||||||||
| Address2: | |||||||||
| City: | OREM | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840585001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8012256246 | ||||||||
| FaxNumber: | 8012251525 | ||||||||
| Practice Location | |||||||||
| Address1: | 11616 S STATE ST STE 1501 | ||||||||
| Address2: | |||||||||
| City: | DRAPER | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840207125 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8014952100 | ||||||||
| FaxNumber: | 8015720925 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/20/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | JENSEN | ||||||||
| AuthorizedOfficialFirstName: | L. | ||||||||
| AuthorizedOfficialMiddleName: | JAMES | ||||||||
| AuthorizedOfficialTitleorPosition: | COO | ||||||||
| AuthorizedOfficialTelephone: | 8012256246 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | JR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | Y | 193200000X MULTI-SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.