OrganizationActive
Tellica Imaging, LLC
NPI 1205554367 · Physiological Laboratory · Bountiful, UT
Provider details
- NPI number
- 1205554367
- Entity type
- Organization
- Primary specialty
- Physiological LaboratoryLaboratories
- Parent organization
- Intermountain Healthcare
- Organization subpart
- Yes
- Authorized official
- Nannette Berensen, Ceo(801) 507-8002
Specialties & taxonomies
Laboratories
- Radiology Clinic/Center261QR0200X
Ambulatory Health Care Facilities
Profile Score
Established profile(60/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
3 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
110 N Main St
Bountiful, UT 84010-6134
Phone: (801) 442-5737
Street-level locationGet directions
Mailing address
36 S State St
Salt Lake City, UT 84111-1401
Registry dates
- Enumerated
- 2022-08-16
- Last updated
- 2023-02-07
- Certified
- 2023-02-07
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.