Western States Medical LLC

Primary specialty

Electroneurodiagnostic Specialist/TechnologistTaxonomy code 246ZE0600X

Legal business name

WESTERN STATES MEDICAL LLC

Practice address

448 E 5350 S Ste B
Washington Terrace, UT 84405-5415

Phone

(801) 540-4564

NPI assigned

Aug 18, 2009

Organization subpart

No

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

Authorized official

Name

Cary Fairbourn

Title

President

Phone

(801) 540-4564

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1250553600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1250553600000",
    "number": "1124250592",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "448 E 5350 S STE B",
            "city": "WASHINGTON TERRACE",
            "state": "UT",
            "postal_code": "844055415"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "448 E 5350 S STE B",
            "city": "WASHINGTON TERRACE",
            "state": "UT",
            "postal_code": "844055415",
            "telephone_number": "801-540-4564"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WESTERN STATES MEDICAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-08-18",
        "last_updated": "2009-08-18",
        "status": "A",
        "authorized_official_last_name": "FAIRBOURN",
        "authorized_official_first_name": "CARY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "801-540-4564"
    },
    "taxonomies": [
        {
            "code": "246ZE0600X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist/Technologist, Other, Electroneurodiagnostic",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Electroneurodiagnostic Specialist/Technologist in Washington Terrace, UT
• Providers in Washington Terrace, UT by specialty
• Electroneurodiagnostic Specialist/Technologist in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2009; 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.