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General NPI Number Information
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NPI Number | 1437488798
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Entity Type | Organization
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Legal Business Name | UTAH PAIN RELIEF INSTITUTE SOUTH, LLC
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Dates
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Enumeration Date | 12/16/2009
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Last Update Date | 05/28/2010
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Provider Practice Location Address
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Address Line | 10464 S REDWOOD RD
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City | SOUTH JORDAN
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State | UT
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Zip | 84095-8501
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Country | US
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Telephone | 801-281-0555
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Fax | 801-281-0444
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Provider Business Mailing Address
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Address Line | 10464 S REDWOOD RD
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City | SOUTH JORDAN
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State | UT
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Zip | 84095-8501
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Country | US
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Telephone | 801-281-0555
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Fax | 801-281-0444
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Authorized Official
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Title or Position | MANAGER
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Name | MRS. JENNIE N NGUYEN
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Credential |
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Telephone | 801-466-7246
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 09W56878
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License Number State | UT
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