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TELLICA IMAGING, LLC
NPI 1205554367
Physiological Laboratory in Bountiful, UT

Active since August 16, 2022
110 N MAIN ST, BOUNTIFUL, UT 84010(801) 442-5737 Get Directions Write a Review

NPPES record last updated: February 7, 2023. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Feb 7, 2023, Jan 4, 2023, Aug 16, 2022 (3 updates tracked since 2022).

About Tellica Imaging, Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

TELLICA IMAGING, LLC (NPI 1205554367) is a healthcare organization registered as a physiological laboratory in Bountiful, Utah and active in the NPI registry since August 2022. The organization lists Nannette Mignon Berensen, Ceo, as its authorized official.

NPPES Registry Identity

NPI1205554367
Entity TypeOrganization
Primary Taxonomy293D00000X
Legal Business NameTELLICA IMAGING, LLC
Location Address110 N MAIN STBountiful, UT 84010-6134
Mailing Address36 S State StSalt Lake City, UT 84111-1401
Phone(801) 442-5737
Organization SubpartYesParent: Intermountain Healthcare
Authorized OfficialNannette Mignon BerensenCeo · (801) 507-8002
Enumeration DateAugust 16, 2022
Last NPPES UpdateFebruary 7, 20233 updates tracked since enumeration
NPPES CertifiedFebruary 7, 2023
✔ NPI 1205554367 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyPhysiological LaboratoryLaboratories
Taxonomy Code293D00000X
Definition
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.
Also ListedClinic/Center · RadiologyTaxonomy 261QR0200X
110 N MAIN ST, Bountiful, UT 84010
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Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Tellica Imaging, LLC's NPI number?

The NPI number for Tellica Imaging, LLC is 1205554367. It was assigned to this organization in the NPPES registry on August 16, 2022.

Where is Tellica Imaging, LLC located?

Tellica Imaging, LLC is located at 110 N Main St, Bountiful, UT 84010. The listed phone number is (801) 442-5737.

What is Tellica Imaging, LLC's specialty?

The primary specialty registered for this NPI is Physiological Laboratory with taxonomy code 293D00000X.

When was this NPI record last updated?

The NPPES record for Tellica Imaging, LLC was last updated on February 7, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.