Organization
NORTHERN UTAH ENDOSCOPY CENTER
Active
Other names
Northern Utah Endoscopy Center, LLC
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DUANE BOHMAN MD (MEMBER)
(435) 787-0270
Entity
Organization
Contact information
Practice address
630 E 1400 N, SUITE 100A, LOGAN, UT 84341-2534
(435) 787-0270
(435) 787-0262
Mailing address
630 E 1400 N, SUITE 100A, LOGAN, UT 84341-2534
(435) 787-0270
(435) 787-0262
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
2006-ASF-16794
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
116023100
—
WY
01
—
2006-ASF-16794
STATE LICENSE
UT
01
—
490004876
RAILROAD MEDICARE
UT
05
—
806091700
—
ID
Enumeration date
03/15/2006
Last updated
04/28/2011
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