Healthcare Provider Details

I. General information

NPI: 1972896793
Provider Name (Legal Business Name): SPERO PAIN RELIEF THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2011
Last Update Date: 05/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

249 E TABERNACLE ST STE 301
ST GEORGE UT
84770-2995
US

IV. Provider business mailing address

PO BOX 2696
ST GEORGE UT
84771-2696
US

V. Phone/Fax

Practice location:
  • Phone: 435-656-1916
  • Fax: 435-656-0444
Mailing address:
  • Phone: 435-656-1916
  • Fax: 435-656-0444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number3541777-4405
License Number StateUT

VIII. Authorized Official

Name: DR. ROBERT WALLACE CHALMERS IV
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 435-656-1916