Tellica Imaging, LLC
NPI 1407438039ActiveOrganization· Physiological Laboratory· West Valley City, UT
Physiological Laboratory in West Valley City, Utah, registered in NPPES in April 2021, part of Intermountain Healthcare. The authorized official on file is Brad Isaacson, PHD, Coo. Enrolled in Medicare as part b supplier - independent diagnostic testing facility (idtf).
Overview
| NPI | 1407438039 |
|---|---|
| Status | Active |
| Entity type | Organization (subpart) |
| Parent organization | Intermountain Healthcare |
| NPI issued | Apr 23, 2021 |
| Last updated in NPPES | Jan 4, 2023 |
| Certified by provider | Jan 4, 2023 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Physiological Laboratory Primary | 293D00000X | — | — |
| Clinic/Center, Radiology | 261QR0200X | — | — |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Oct 9, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 10, 2026 | No match | — |
| New York OMIG · Nov 10, 2026 | No match | — |
| Ohio Medicaid · Nov 10, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 10, 2026 | No match | — |
| Washington HCA · Nov 10, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Part B Supplier - Independent Diagnostic Testing Facility (Idtf) (UT) |
|---|
Other Physiological Laboratory providers in West Valley City
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