OrganizationActive
Tellica Imaging, LLC
NPI 1407438039 · Physiological Laboratory · West Valley City, UT
Provider details
- NPI number
- 1407438039
- Entity type
- Organization
- Primary specialty
- Physiological LaboratoryLaboratories
- Parent organization
- Intermountain Healthcare
- Organization subpart
- Yes
- Authorized official
- Brad Isaacson, Coo(801) 442-5737
Specialties & taxonomies
Laboratories
- Radiology Clinic/Center261QR0200X
Ambulatory Health Care Facilities
Profile Score
Established profile(62/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
5 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
4587 S 4000 W
West Valley City, UT 84120-6317
Phone: (801) 442-5737
Street-level locationGet directions
Mailing address
36 S State St
Salt Lake City, UT 84111-1401
Registry dates
- Enumerated
- 2021-04-23
- Last updated
- 2023-01-04
- Certified
- 2023-01-04
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.