Healthcare Provider Details

I. General information

NPI: 1700234499
Provider Name (Legal Business Name): SOUTHWEST SPINE AND PAIN CARE SPECIALISTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2016
Last Update Date: 03/12/2026
Certification Date: 03/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

691 E 400 N STE 110
VINEYARD UT
84059-7509
US

IV. Provider business mailing address

PO BOX 912042
ST GEORGE UT
84791-2042
US

V. Phone/Fax

Practice location:
  • Phone: 385-203-0246
  • Fax: 385-203-0245
Mailing address:
  • Phone: 435-215-0230
  • Fax: 435-656-2828

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DEREK LEE FRIEDEN
Title or Position: MANAGING PARTNER
Credential:
Phone: 435-215-0230