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General NPI Number Information
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NPI Number | 1528953791
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Entity Type | Organization
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Legal Business Name | PAIN MANAGEMENT PI
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Dates
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Enumeration Date | 06/10/2025
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Last Update Date | 06/10/2025
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Provider Practice Location Address
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Address Line | 6770 S 900 E STE 1001515
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City | MIDVALE
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State | UT
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Zip | 84047-1709
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Country | US
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Telephone | 801-755-7181
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Fax |
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Provider Business Mailing Address
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Address Line | 1515 E FORT UNION BLVD
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City | COTTONWOOD HEIGHTS
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State | UT
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Zip | 84121-2855
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Country | US
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Telephone | 801-755-7181
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Fax |
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Authorized Official
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Title or Position | HEALTHCARE ADMINISTRATOR
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Name | PEDRO LIRA
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Credential |
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Telephone | 801-755-7181
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WP0000X
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Taxonomy Name | Pain Management Registered Nurse
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License Number |
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License Number State |
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