NPIMap

Organization Active NPI

Lakeview Neurosurgery Clinic, LLC

  • Neurology Physician
  • Bountiful, UT
National Provider Identifier
1831202118
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
Legal business name
LAKEVIEW NEUROSURGERY CLINIC, LLC
Practice address
620 Medical Dr
Suite 300
Bountiful, UT 84010-5084
Phone
(801) 299-3871
NPI assigned
Aug 17, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Jeff Rydburg
Title
VP
Phone
(801) 299-3871

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084N0400X Primary

Addresses

Primary practice location

620 Medical Dr
Suite 300
Bountiful, UT 84010-5084

Mailing address

620 Medical Dr
Suite 300
Bountiful, UT 84010-5084
Phone (801) 299-3871

National Provider Directory

National Provider Directory
Tax ID family
Lakeview Neurosurgery Clinic LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

NPI Registry JSON

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

{
    "created_epoch": "1155772800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1831202118",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "620 MEDICAL DR",
            "address_2": "SUITE 300",
            "city": "BOUNTIFUL",
            "state": "UT",
            "postal_code": "840105084",
            "telephone_number": "801-299-3871"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "620 MEDICAL DR",
            "address_2": "SUITE 300",
            "city": "BOUNTIFUL",
            "state": "UT",
            "postal_code": "840105084",
            "telephone_number": "801-299-3871"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKEVIEW NEUROSURGERY CLINIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-17",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "RYDBURG",
        "authorized_official_first_name": "JEFF",
        "authorized_official_title_or_position": "VP",
        "authorized_official_telephone_number": "801-299-3871"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bountiful, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.