Provider Demographics
NPI:1689226391
Name:UTAH INTERMOUNTAIN PAIN MANAGEMENT
Entity type:Organization
Organization Name:UTAH INTERMOUNTAIN PAIN MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-816-0332
Mailing Address - Street 1:10376 S JORDAN GTWY
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-3954
Mailing Address - Country:US
Mailing Address - Phone:801-816-0332
Mailing Address - Fax:801-816-0331
Practice Address - Street 1:8822 S REDWOOD RD STE 113
Practice Address - Street 2:
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84088-9341
Practice Address - Country:US
Practice Address - Phone:801-816-0332
Practice Address - Fax:801-816-0331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-12
Last Update Date:2019-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty