Organization
WESTERN INTERMOUNTAIN LITHOTRIPSY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DAVID NEIL KOOYMAN (CEO/BUSINESS MANAGER)
(435) 757-6264
Entity
Organization
Contact information
Practice address
862 GARDEN CIR, LOGAN, UT 84321-6465
(801) 964-1200
(801) 964-1344
Mailing address
PO BOX 160515, CLEARFIELD, UT 84016-0515
(801) 779-4955
(801) 774-8874
Taxonomy
Speciality
Code
Description
License number
State
261QL0400X
Lithotripsy Clinic/Center
Primary
2055
UT
Other
Enumeration date
08/30/2007
Last updated
08/07/2013
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