TELLICA IMAGING, LLC – NPI #1710605696
Physiological Laboratory

A laboratory that operates independently of a hospital and physician's office to furnish physiological diagnostic services (e.g. EEG's , EKG's, scans, etc.). Facilities offering ONLY physiological services are not certified as independent laboratories. If an independent laboratory offers physiological services IN ADDITION to clinical laboratory services, they are surveyed only for compliance with the clinical laboratory regulations because there are no health and safety regulations for physiological services.

Health Care Provider Taxonomy Code for Physiological Laboratory

TELLICA IMAGING, LLC is a physiological laboratory located in DRAPER, UT. NPPES has assigned the NPI number 1710605696 to TELLICA IMAGING, LLC on August 17, 2022. It is a Type-2 NPI, indicating this NPI number is associated with an organization. With multiple taxonomy codes selected, the primary taxonomy selected by this provider is 293D00000X from the Health Care Provider Taxonomy code set, which is classified as Physiological Laboratory.

The NPI profile was previously updated about 3 years ago on Feb 07, 2023. Use the NPI data found here to bill health insurance companies, identify providers enrolled in Medicare and Medicaid services or other HIPAA compliant transactions. See the complete NPI profile for TELLICA IMAGING, LLC below.

NPI Profile for
TELLICA IMAGING, LLC

NPI Number
1710605696
Enumeration Date

(about 4 years ago)
Entity Type
Type-2  Organization
Organization health care providers may have a single employee or thousands of employees. An example is an incorporated individual who is an organization's only employee.
Legal Name
TELLICA IMAGING, LLC
Primary location
195 W 13290 S
DRAPER, UT 84020
Phone: (801) 442-5737 Fax:
Mailing address
36 S STATE ST
SALT LAKE CITY, UT 84111-1401
Phone: Fax:
Organization Subpart
Yes - TELLICA IMAGING, LLC is subpart of another organization.
Authorized Official
NANNETTE BERENSEN
CEO
Phone: (801) 507-8002
Updated
Certification Date
Feb 07, 2023

Note: NPPES allows providers to attest to the accuracy of their NPI data. When a provider request any change to the NPI record, they will be able to attest to their changed NPI data, resulting in an updated certification date.

Taxonomy Code(s)

A taxonomy code is a code that describes the health care service provider's type, classification, and the area of specialization. The primary specialty for this provider is indicated as (Primary) below.

Taxonomy Classification / Specialization State License
293D00000X
- Physiological Laboratory (Primary)
261QR0200X
- Clinic/Center / Radiology

The taxonomy codes are selected by the provider at the time of NPI registration. Selection of a taxonomy code does not replace any credentialing or validation process that the provider requesting the code should complete.