| Dr Travis Jay Canova, DO | |
|
1232 N 2560 W, Clinton, UT 84015-2773 | |
| (801) 549-7227 | |
| Not Available |
| Full Name | Dr Travis Jay Canova |
|---|---|
| Gender | Male |
| Speciality | Diagnostic Radiology |
| Experience | 12 Years |
| Location | 1232 N 2560 W, Clinton, Utah |
| Accepts Medicare Assignments | Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144635269 | NPI | - | NPPES |
| 200067468 | Medicaid | MO | |
| ENROLLED | Medicaid | IL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2085R0202X | Radiology - Diagnostic Radiology | 11629842-1204 (Utah) | Primary |
| Facility Name | Location | Facility Type |
|---|---|---|
| St Mark's Hospital | Salt lake city, UT | Hospital |
| Ogden Regional Medical Center | Ogden, UT | Hospital |
| Mountain West Medical Center | Tooele, UT | Hospital |
| Lone Peak Hospital | Draper, UT | Hospital |
| Lakeview Hospital | Bountiful, UT | Hospital |
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|---|---|
| Utah Imaging Associates Inc | 1355394537 | 43 |
| Tooele Valley Imaging Llc | 2466624630 | 23 |
| Green River Radiology Pc | 5294123063 | 23 |
| Entity Name | Utah Imaging Associates Inc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1629076229 PECOS PAC ID: 1355394537 Enrollment ID: O20050228000845 |
| Entity Name | Wasatch Imaging Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1679645139 PECOS PAC ID: 7012949522 Enrollment ID: O20050906000837 |
| Entity Name | Tooele Valley Imaging Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1699004499 PECOS PAC ID: 2466624630 Enrollment ID: O20111012000146 |
| Entity Name | Oquirrh Radiology Associates Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1568734143 PECOS PAC ID: 4082875448 Enrollment ID: O20120411000273 |
| Entity Name | Green River Radiology Pc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1508533878 PECOS PAC ID: 5294123063 Enrollment ID: O20211027002062 |
| Mailing Address | Practice Location Address |
|---|---|
| Dr Travis Jay Canova, DO 1232 N 2560 W, Clinton, UT 84015-2773 Ph: (801) 549-7227 | Dr Travis Jay Canova, DO 1232 N 2560 W, Clinton, UT 84015-2773 Ph: (801) 549-7227 |