Healthcare Provider Details

I. General information

NPI: 1770812034
Provider Name (Legal Business Name): UTAH PAIN RELIEF NORTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2009
Last Update Date: 03/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8822 S REDWOOD RD
WEST JORDAN UT
84088-9336
US

IV. Provider business mailing address

8822 S REDWOOD RD
WEST JORDAN UT
84088-9336
US

V. Phone/Fax

Practice location:
  • Phone: 801-466-7246
  • Fax: 801-281-0444
Mailing address:
  • Phone: 801-466-7246
  • Fax: 801-281-0444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number09W56823
License Number StateUT

VIII. Authorized Official

Name: MRS. JENNIE N NGUYEN
Title or Position: MANAGER
Credential:
Phone: 801-448-4422