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TELLICA IMAGING, LLC

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Company Details

Name: TELLICA IMAGING, LLC
Jurisdiction: Idaho
Legal type: Foreign Limited Liability Company
Status: Active-Existing
Date of registration: 11 Jul 2023 (2 years ago)
Financial Date End: 31 Jul 2025
Entity Number: 5314925
Place of Formation: UTAH
File Number: 887769
Principal Address: LEGAL 36 SOUTH STATE STREET, SUITE 2200 SALT LAKE CITY, UT 84111
Mailing Address: LEGAL STE 2200 36 S STATE ST SALT LAKE CITY, UT 84111-1470

Agent

Name Role Address
INCORP SERVICES, INC. Agent 1310 S VISTA AVE, STE 28, BOISE, ID 83705

Member

Name Role Address Appointed On
INTERMOUNTAIN HEALTH CARE, INC. Member 36 SOUTH STATE STREET, SUITE 2200, SALT LAKE CITY, UT 84111 2024-10-05

National Provider Identifier

NPI Number:
1760197198
Certification Date:
2023-11-20

Authorized Person:

Name:
MARK L VAWDREY
Role:
CFO
Phone:

Taxonomy:

Selected Taxonomy:
2085R0202X - Diagnostic Radiology Physician
Is Primary:
No
Selected Taxonomy:
261QR0200X - Radiology Clinic/Center
Is Primary:
Yes

Contacts:

Fax:
2084175105

Filing

Filing Name Filing Number Filing date
Annual Report 0005929886 2024-10-05
Initial Filing 0005314925 2023-07-11

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Date of last update: 27 Mar 2025

Sources: Idaho Secretary of State