MTD Medical Services, LLC

Primary specialty

Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X

License

180791-1205 Issued in UT

Legal business name

MTD MEDICAL SERVICES, LLC

Practice address

290 N Red Slide Dr
Wellsville, UT 84339-9757

Phone

(435) 716-5489

Fax

(435) 716-5442

NPI assigned

Feb 18, 2010

Organization subpart

No

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

Authorized official

Name

Dr. Jonathan Frohse Koehler, MD

Title

Manager

Phone

(435) 716-5489

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1266451200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1296000000000",
    "number": "1861714768",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "290 N RED SLIDE DR",
            "city": "WELLSVILLE",
            "state": "UT",
            "postal_code": "843399757",
            "telephone_number": "435-716-5489",
            "fax_number": "435-716-5442"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "290 N RED SLIDE DR",
            "city": "WELLSVILLE",
            "state": "UT",
            "postal_code": "843399757",
            "telephone_number": "435-716-5489",
            "fax_number": "435-716-5442"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MTD MEDICAL SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-02-18",
        "last_updated": "2011-01-26",
        "status": "A",
        "authorized_official_last_name": "KOEHLER",
        "authorized_official_first_name": "JONATHAN",
        "authorized_official_middle_name": "FROHSE",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "435-716-5489",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "UT",
            "license": "180791-1205",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• All providers in Wellsville, UT
• Anatomic Pathology & Clinical Pathology Physician in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2011; 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.