NPIMap

Organization Active NPI

Tellica Imaging, LLC

  • Radiology Clinic/Center
  • Manchester, NH
National Provider Identifier
1457055774
Registry record updated Aug 27, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Radiology Clinic/CenterTaxonomy code 261QR0200X
Legal business name
TELLICA IMAGING, LLC
Practice address
1100 Bicentennial Dr Ste 3B
Manchester, NH 03104-2173
Phone
(603) 292-3491
NPI assigned
Mar 29, 2023
Organization subpart
Yes
Parent organization
INTERMOUNTAIN HEALTHCAREAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 27, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mark Vawdrey
Title
Chief Financial Officer
Phone
(801) 718-1642

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2085R0202X
Radiology Clinic/Center 261QR0200X Primary

Addresses

Primary practice location

1100 Bicentennial Dr Ste 3B
Manchester, NH 03104-2173

Mailing address

36 S State St Ste 2200
Salt Lake City, UT 84111-1470

National Provider Directory

National Provider Directory
Tax ID family
Tellica Imaging LLC10 organizations share this tax ID, including this one
Part of
Duchesne Valley Clinic

Other organizations with this tax ID 9

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1100 Bicentennial Dr
Ste 3B
Manchester, NH 03104
Phone (603) 292-3491

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1680048000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1756252800000",
    "number": "1457055774",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "36 S STATE ST STE 2200",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841111470"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 BICENTENNIAL DR STE 3B",
            "city": "MANCHESTER",
            "state": "NH",
            "postal_code": "031042173",
            "telephone_number": "603-292-3491"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TELLICA IMAGING, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "INTERMOUNTAIN HEALTHCARE",
        "enumeration_date": "2023-03-29",
        "last_updated": "2025-08-27",
        "certification_date": "2025-08-27",
        "status": "A",
        "authorized_official_last_name": "VAWDREY",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "801-718-1642"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Manchester, NH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.