MEDICARE: LIFE SPRING PAIN MANAGEMENT, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QH0100X	Health Service Clinic/Center	5867389-1205	UT
2	261QH0100X	Health Service Clinic/Center	5867369-1205	UT

General Provider Information

NPI Number	:	1699115188
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFE SPRING PAIN MANAGEMENT, LLC

Provider Business Mailing Address
First Line	:	275 W 200 N
Second Line	:	STE 7
City	:	KAYSVILLE
State	:	UT
Zip	:	84037-1861
Country	:	US
Telephone Number	:	801-546-1300
Fax Number	:

Provider Business Practice Location Address
First Line	:	275 W 200 N
Second Line	:	STE 7
City	:	KAYSVILLE
State	:	UT
Zip	:	84037-1861
Country	:	US
Telephone Number	:	801-546-1300
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. CHRISTIAN C OBAH
Credential	:	MD
Telephone Number	:	801-786-9030

Provider Enumeration Date	:	06/27/2013
Last Update Date	:	09/03/2013

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