WESTERN STATES MEDICAL LLC (NPI# 1124250592) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1124250592 |
| Entity Type | Organization |
| Organization Name | WESTERN STATES MEDICAL LLC |
| Practice Address |
448 E 5350 S Ste B Washington Terrace UT 84405-5415 |
| Practice Telephone | 8015404564 |
| Enumeration Date | 2009-08-18 |
| Last Update Date | 2009-08-18 |
| Authorized Official Name | CARY FAIRBOURN (PRESIDENT) |
| Authorized Official Telephone | 8015404564 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 246ZE0600X |
Specialist/Technologist, Other Specialization: Electroneurodiagnostic |
Technologists, Technicians & Other Technical Service Providers |
| Street Address |
448 E 5350 S STE B |
| City | WASHINGTON TERRACE |
| State | UT |
| Zip Code | 84405-5415 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508098906 | Timber Ridge Holdings LLC | Psychiatry & Neurology | 448 E 5350 S Ste B, Washington Terrace, UT 84405-5415 | 2009-08-18 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669028171 | Alyssa House | Behavioral Analyst | 4933 1500 West #110, Riverdale, UT 84405 | 2019-08-12 |
| 1518525989 | Petersen Farms Assisted Living & Memory Care | Assisted Living Facility | 6980 S. 475 E., South Weber, UT 84405 | 2019-05-31 |
| 1376038141 | National Vision, Inc. | Technician/Technologist | 821 West Riverdale Road, Riverdale, UT 84405 | 2018-06-25 |
| 1194218461 | South Weber City | Ambulance | 7365 S 1375 E, South Weber, UT 84405 | 2018-06-12 |
| 1528572682 | Sandra Jo Scott | Dental Hygienist | 264 W Ridgeline Dr, Washington Terrace, UT 84405 | 2017-11-28 |
| 1376079061 | Loretta Shupe | Registered Nurse | 5319 S 500 E, Ogden, UT 84405 | 2017-05-02 |
| 1134661374 | Randy Ferrin | Registered Nurse | 5697 Maplewood Drive, South Ogden, UT 84405 | 2016-11-04 |
| 1871046284 | Karla Rosen | Counselor | 5202 S. Freeway Park Dr., Riverdale, UT 84405 | 2016-08-02 |
| 1053784520 | Jenifer Rebecca Nilson Smith | Physical Therapist | 5648 S. Adams Ave, Washington Terrace, UT 84405 | 2015-11-05 |
| 1972976454 | Jenniferlyn Fletcher | Physical Therapy Assistant | 5648 South Adams Ave, Washington Terrace, UT 84405 | 2015-11-05 |
| Find all providers in zip 84405 | ||||
| Taxonomy Code | 246ZE0600X |
| Grouping | Technologists, Technicians & Other Technical Service Providers |
| Classification | Specialist/Technologist, Other |
| Specialization | Electroneurodiagnostic |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831573484 | Elsha Cachet Russell | Specialist/Technologist, Other | 448 E 5350 S, Suite B, Washington Terrace, UT 84405-5414 | 2015-07-14 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174160097 | Axon Neuromonitoring | Specialist/Technologist, Other | 10193 S Millbury Way, Sandy, UT 84092-3823 | 2019-12-10 |
| 1811354939 | Ryan Merrill | Specialist/Technologist, Other | 993 S Suncrest Cir, Kaysville, UT 84037-9434 | 2016-01-20 |
| 1427433242 | Matthew Robins | Specialist/Technologist, Other | 1960 E 1425 N, Layton, UT 84040-8204 | 2015-07-22 |
| 1184923278 | Intermountain Epilepsy & Sleep Center, Inc | Specialist/Technologist, Other | 5323 Woodrow St., Suite 203, Murray, UT 84107-5851 | 2011-03-15 |
| 1356350987 | Dallas Kent Ward | Specialist/Technologist, Other | 294 S 850 E, Kaysville, UT 84037-2220 | 2006-08-05 |
| 1447713888 | Axon Iom LLC | Specialist/Technologist, Other | 294 S 850 E, Kaysville, UT 84037-2220 | 2019-04-11 |
| 1396256293 | Craniom | Specialist/Technologist, Other | 1490 E Foremaster Dr, St George, UT 84790-4488 | 2017-10-18 |
| 1154631505 | Ambulatory Neurological Services, LLC | Specialist/Technologist, Other | 8541 S Redwood Rd, Ste A1, West Jordan, UT 84088-9327 | 2010-10-19 |
| City | WASHINGTON TERRACE |
| Zip Code | 84405 |
Please comment or provide details below to improve the information on WESTERN STATES MEDICAL LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.