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General NPI Number Information
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NPI Number | 1417253907
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Entity Type | Organization
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Legal Business Name | OMEGA INTERVENTIONAL PAIN PLLC
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Dates
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Enumeration Date | 02/01/2011
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Last Update Date | 10/24/2023
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Provider Practice Location Address
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Address Line | 3838 S 700 E STE 300
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City | SALT LAKE CITY
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State | UT
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Zip | 84106-1466
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Country | US
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Telephone | 801-261-4988
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Fax | 801-269-9425
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Provider Business Mailing Address
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Address Line | 3838 S 700 E STE 300
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City | SALT LAKE CITY
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State | UT
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Zip | 84106-1466
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Country | US
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Telephone | 801-261-4988
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | STEVEN PULLEY
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Credential | MD
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Telephone | 801-261-4988
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2084P2900X
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Taxonomy Name | Pain Medicine (Psychiatry & Neurology) Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number |
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License Number State |
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