Northern Utah Endoscopy Center

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

2006-ASF-16794 Issued in UT

Legal business name

NORTHERN UTAH ENDOSCOPY CENTER

Practice address

630 E 1400 N
Suite 100a
Logan, UT 84341-2534

Phone

(435) 787-0270

Fax

(435) 787-0262

NPI assigned

Mar 15, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Duane Bohman, MD

Title

Member

Phone

(435) 787-0270

Specialties & licenses 1

Addresses

Other identifiers 4

Other names 1

• Northern Utah Endoscopy Center, LLC Other name

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Verle Duane Bohman, M.D.

  • Gastroenterology Physician
  • Logan, UT
  • NPI 1336105360
  NPD (past)
• Dirk R. Davis, M.D.

  • Gastroenterology Physician
  • Logan, UT
  • NPI 1134187263
  NPD (past)
• Bryan R. Larsen, M.D.

  • Gastroenterology Physician
  • Logan, UT
  • NPI 1972561165
  NPD (past)

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

{
    "created_epoch": "1142380800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1303948800000",
    "number": "1902875669",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "630 E 1400 N",
            "address_2": "SUITE 100A",
            "city": "LOGAN",
            "state": "UT",
            "postal_code": "843412534",
            "telephone_number": "435-787-0270",
            "fax_number": "435-787-0262"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "630 E 1400 N",
            "address_2": "SUITE 100A",
            "city": "LOGAN",
            "state": "UT",
            "postal_code": "843412534",
            "telephone_number": "435-787-0270",
            "fax_number": "435-787-0262"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHERN UTAH ENDOSCOPY CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-15",
        "last_updated": "2011-04-28",
        "status": "A",
        "authorized_official_last_name": "BOHMAN",
        "authorized_official_first_name": "DUANE",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "435-787-0270",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "UT",
            "license": "2006-ASF-16794",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "490004876",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "2006-ASF-16794",
            "state": "UT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "806091700",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "116023100",
            "state": "WY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Northern Utah Endoscopy Center, LLC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Christian D Nilson, MD PC
• Nolan a. White, D.C., P.C.
• Barry A Noorda, MD
• Cheryl Norr
• North Logan PDC PLLC
• Northern Utah Eye Center
• Northern Utah Gastroenterology and Endoscopy Specialists LLC
• Northern Utah Pathology PC
• Northern Utah Surgery Center, LLC
• Northern Utah Surgicenter, LLC

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 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.