Western Intermountain Lithotripsy

Primary specialty

Lithotripsy Clinic/CenterTaxonomy code 261QL0400X

License

2055 Issued in UT

Legal business name

WESTERN INTERMOUNTAIN LITHOTRIPSY

Practice address

862 Garden Cir
Logan, UT 84321-6465

Phone

(801) 964-1200

Fax

(801) 964-1344

NPI assigned

Aug 30, 2007

Organization subpart

No

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

Authorized official

Name

Mr. David Neil Kooyman

Title

Ceo/Business Manager

Phone

(435) 757-6264

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1188432000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1375833600000",
    "number": "1679767834",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 160515",
            "city": "CLEARFIELD",
            "state": "UT",
            "postal_code": "840160515",
            "telephone_number": "801-779-4955",
            "fax_number": "801-774-8874"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "862 GARDEN CIR",
            "city": "LOGAN",
            "state": "UT",
            "postal_code": "843216465",
            "telephone_number": "801-964-1200",
            "fax_number": "801-964-1344"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WESTERN INTERMOUNTAIN LITHOTRIPSY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-30",
        "last_updated": "2013-08-07",
        "status": "A",
        "authorized_official_last_name": "KOOYMAN",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "NEIL",
        "authorized_official_title_or_position": "CEO/BUSINESS MANAGER",
        "authorized_official_telephone_number": "435-757-6264",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QL0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Lithotripsy",
            "state": "UT",
            "license": "2055",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jeffrey David Wegener, D.M.D.
• Kenneth George Weigand, PSY D
• Bartley M Weiss, MD
• Matthew John Welter, M.D.
• Kristin Michelle West, ATC-L
• Westmed Pharmacy
• Reta Whalen, LCSW
• Dennis Wheatley, LMFT
• Erin Elizabeth Wheatley, M.ED., BCBA, LBA
• Kent B Whitaker, PA

• Clinic/Center in Logan, UT
• Providers in Logan, UT by specialty
• Clinic/Center in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2013; 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.