Healthcare Provider Details

I. General information

NPI: 1275899114
Provider Name (Legal Business Name): UTAH CENTRAL PAIN MANAGEMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2012
Last Update Date: 08/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

435 S MAIN ST
EPHRAIM UT
84627-1317
US

IV. Provider business mailing address

435 S MAIN ST
EPHRAIM UT
84627-1317
US

V. Phone/Fax

Practice location:
  • Phone: 435-283-4069
  • Fax: 435-283-0372
Mailing address:
  • Phone: 435-283-4069
  • Fax: 435-283-0372

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. CHARLES A. HOWARD
Title or Position: MANAGER
Credential: D.C.
Phone: 435-283-4069