Healthcare Provider Details

I. General information

NPI: 1376844886
Provider Name (Legal Business Name): OSTEOARTHRITIS CENTERS OF AMERICA MEDICAL GROUP PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2010
Last Update Date: 07/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14587 S 790 W STE A
BLUFFDALE UT
84065-2320
US

IV. Provider business mailing address

14587 S 790 W STE A STE A
BLUFFDALE UT
84065-2320
US

V. Phone/Fax

Practice location:
  • Phone: 801-478-2526
  • Fax: 801-931-2498
Mailing address:
  • Phone: 801-478-2526
  • Fax: 801-931-2498

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JAMES SCHRADER
Title or Position: COO
Credential:
Phone: 801-856-9778