Provider Demographics
NPI:1609538552
Name:RYAN WESTBROEK LLC
Entity Type:Organization
Organization Name:RYAN WESTBROEK LLC
Other - Org Name:WESTBROEK FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-391-6617
Mailing Address - Street 1:4126 S 5000 W
Mailing Address - Street 2:
Mailing Address - City:WEST HAVEN
Mailing Address - State:UT
Mailing Address - Zip Code:84401-9403
Mailing Address - Country:US
Mailing Address - Phone:801-529-8935
Mailing Address - Fax:801-627-2228
Practice Address - Street 1:3500 HARRISON BLVD STE 200
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-2038
Practice Address - Country:US
Practice Address - Phone:801-515-7997
Practice Address - Fax:385-333-7413
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-07
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty