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General NPI Number Information
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NPI Number | 1861714768
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Entity Type | Organization
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Legal Business Name | MTD MEDICAL SERVICES, LLC
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Dates
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Enumeration Date | 02/18/2010
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Last Update Date | 01/26/2011
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Provider Practice Location Address
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Address Line | 290 N RED SLIDE DR
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City | WELLSVILLE
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State | UT
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Zip | 84339-9757
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Country | US
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Telephone | 435-716-5489
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Fax | 435-716-5442
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Provider Business Mailing Address
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Address Line | 290 N RED SLIDE DR
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City | WELLSVILLE
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State | UT
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Zip | 84339-9757
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Country | US
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Telephone | 435-716-5489
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Fax | 435-716-5442
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Authorized Official
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Title or Position | MANAGER
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Name | DR. JONATHAN FROHSE KOEHLER
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Credential | MD
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Telephone | 435-716-5489
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | 180791-1205
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License Number State | UT
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