Healthcare Provider Details

I. General information

NPI: 1144343823
Provider Name (Legal Business Name): ZION PAIN MANAGEMENT CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 04/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 N 200 E SUITE 2A
ST GEORGE UT
84770-3040
US

IV. Provider business mailing address

301 N 200 E SUITE 2A
ST GEORGE UT
84770-3010
US

V. Phone/Fax

Practice location:
  • Phone: 435-688-7246
  • Fax: 435-688-1363
Mailing address:
  • Phone: 435-688-7246
  • Fax: 435-688-1363

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: DALE GERALD STOTT
Title or Position: PRESIDENT
Credential: MD
Phone: 435-688-7246