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General NPI Number Information
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NPI Number | 1154144459
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Entity Type | Organization
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Legal Business Name | SMITH'S PAIN MANAGEMENT
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Dates
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Enumeration Date | 11/05/2024
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Last Update Date | 11/05/2024
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Provider Practice Location Address
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Address Line | 10648 S REMBRANDT LN
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City | SANDY
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State | UT
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Zip | 84070-5224
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Country | US
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Telephone | 435-313-3142
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Fax | 801-705-0118
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Provider Business Mailing Address
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Address Line | 10648 S REMBRANDT LN
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City | SANDY
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State | UT
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Zip | 84070-5224
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Country | US
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Telephone | 435-313-3142
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Fax | 801-705-0118
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Authorized Official
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Title or Position | NURSE PRACTITIONER/OWNER
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Name | MRS. DIANE SMITH
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Credential | NP-C
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Telephone | 435-313-3142
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP3300X
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Taxonomy Name | Pain Clinic/Center
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License Number |
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License Number State |
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