SOUTHWEST SPINE AND PAIN CARE SPECIALISTS, LLC (NPI# 1891320644) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1891320644 |
| Entity Type | Organization |
| Organization Name | SOUTHWEST SPINE AND PAIN CARE SPECIALISTS, LLC |
| Practice Address |
301 N 200 E Ste 2a St George UT 84770-3040 |
| Mailing Address |
652 S Medical Center Dr Ste 110 St George UT 84790-7077 |
| Practice Telephone | 4356887246 |
| Practice Fax Number | 4356881363 |
| Mailing Telephone | 4352150230 |
| Mailing Fax Number | 4359867092 |
| Enumeration Date | 2020-03-11 |
| Last Update Date | 2020-03-11 |
| Authorized Official Name | DEREK LEE FRIEDEN (MANAGING PARTNER) |
| Authorized Official Telephone | 4356562424 |
| Is Organization Subpart | Y |
| Parent Organization Name | SOUTHWEST SPINE AND PAIN CARE SPECIALISTS, LLC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 111N00000X | Chiropractor | Chiropractic Providers | ||
| N | 111NS0005X |
Chiropractor Specialization: Sports Physician |
Chiropractic Providers | ||
| N | 225100000X | Physical Therapist | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | ||
| Y | 207LP2900X |
Anesthesiology Specialization: Pain Medicine |
Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Southwest Spine and Pain Center | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003441858 | Southwest Spine and Pain Care Specialists, LLC | Clinical Medical Laboratory | 2051 E Red Hills Pkwy Ste 7, St George, UT 84770-8671 | 2020-03-11 |
| Street Address |
301 N 200 E STE 2A |
| City | ST GEORGE |
| State | UT |
| Zip Code | 84770-3040 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932430782 | Russell D. Jepson | Chiropractor | 301 N 200 E Ste 2a, St George, UT 84770-3040 | 2010-01-19 |
| 1407159130 | Brian Dwayne Lefler | Physician Assistant | 301 N 200 E Ste 2a, St George, UT 84770-3040 | 2010-12-20 |
| 1447571385 | Stacie L Oliver | Anesthesiology | 301 N 200 E Ste 2a, St George, UT 84770-3040 | 2010-06-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740808500 | Redstone Reference Laboratories Inc | Clinical Medical Laboratory | 556 N Dixie Drive, Suite 2, St George, UT 84770 | 2020-07-08 |
| 1033776315 | Ecko Ashmore | Marriage & Family Therapist | 1173 S. 250 W. Bld 1 Ste 208, St. George, UT 84770 | 2019-05-22 |
| 1740844679 | Amy Darragh | Behavior Technician | 249 E Tabernacle St, Ste 100, St George, UT 84770 | 2019-04-25 |
| 1124598198 | Loren Kyle Gulbranson | Internal Medicine | Dixie Regional Medical Center, 515 South, 300 East, Saint George, UT 84770 | 2018-12-03 |
| 1487150728 | Sound Sleep Medical LLC | Durable Medical Equipment & Medical Supplies | 640 East 700 South Building 2, St. George, UT 84770 | 2018-04-04 |
| 1588162911 | Desert Edge Medical | Family Medicine | 1664 S Dixie Dr Ste D201, St George, UT 84770 | 2018-01-31 |
| 1568981314 | Jeffrey Joseph Peterson | Behavior Technician | 162 N 400 E Ste A-105, St. George, UT 84770 | 2017-09-13 |
| 1992242549 | Zachary Carey | Specialist/Technologist | 1115 W Diamond Valley Dr, Saint George, UT 84770 | 2017-01-20 |
| 1669920427 | Charles Taylor Church | Technician, Other | 474 West 200 East, St. George, UT 84770 | 2016-09-21 |
| 1952755480 | Hollystic Hideaway | Voluntary or Charitable | 1418 W Sunset Blvd. # 2, Saint George, UT 84770 | 2016-04-21 |
| Find all providers in zip 84770 | ||||
| Taxonomy Code | 207LP2900X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Anesthesiology |
| Specialization | Pain Medicine |
| An anesthesiologist who provides a high level of care, either as a primary physician or consultant, for patients experiencing problems with acute, chronic and/or cancer pain in both hospital and ambulatory settings. Patient care needs are also coordinated with other specialists. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Anesthesiology, 2007. http://www.theaba.org/; American Osteopathic Board of Anesthesiology, 2007, http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Anesthesiology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Anesthesiology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205058294 | Joseph Courtney Empey | Anesthesiology | 617 E Riverside Dr Ste 301, St George, UT 84790-8722 | 2007-05-02 |
| 1164421053 | Dale Gerald Stott | Anesthesiology | 301 N 200 E, Suite 2a, St George, UT 84770-3010 | 2005-07-21 |
| 1447571385 | Stacie L Oliver | Anesthesiology | 301 N 200 E Ste 2a, St George, UT 84770-3040 | 2010-06-15 |
| 1043473358 | David A Debenham Md PC | Anesthesiology | 620 S 400 E, Suite 201, St George, UT 84770-3700 | 2008-07-07 |
| 1831359298 | Dale G Stott Md PC | Anesthesiology | 301 N 200 E, Suite 2a, St George, UT 84770-3010 | 2008-06-10 |
| 1659559367 | Anesthesia Consultants LLC | Anesthesiology | 640 E 700 S Ste 10b, St George, UT 84770-4036 | 2008-02-05 |
| 1356444863 | St George Surgical Center Lp | Anesthesiology | 676 S Bluff St, St George, UT 84770-3596 | 2006-09-07 |
| 1205814803 | Jon B Obray | Anesthesiology | 652 S Medical Center Dr, Ste. 110, St George, UT 84790-7049 | 2006-01-04 |
| 1528059201 | Derek Lee Frieden | Anesthesiology | 652 S Medical Center Dr, Ste 110, St George, UT 84790-7017 | 2005-11-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952865412 | Avail Medical LLC | Anesthesiology | 5742 S 1475 E Ste 200, South Ogden, UT 84403-4856 | 2019-01-29 |
| 1033597257 | Ashley Renee Donaldson | Anesthesiology | Spinal Interventions, 280 W River Park Drive Suite 200, Provo, UT 84604 | 2015-05-07 |
| 1609204338 | Interventional Spine & Pain Management | Anesthesiology | 5801 S Fashion Blvd Ste 180, Murray, UT 84107-8135 | 2013-10-15 |
| 1225387491 | Clinton D. Olsen | Anesthesiology | 280 W River Park Dr, Suite 200, Provo, UT 84604-5793 | 2012-09-04 |
| 1134429384 | Intermountain Medical Monitoring LLC | Anesthesiology | 1306 Deer Crest, Fruit Heights, UT 84037 | 2010-10-21 |
| 1861622219 | Jeremy Joyal | Anesthesiology | 11760 S 700 E Ste 112, Draper, UT 84020-6605 | 2009-07-20 |
| 1962439570 | Gordon Petty George, Md, PC | Anesthesiology | 800 N 700 W, Ste 340a, Orem, UT 84057 | 2006-06-27 |
| 1770558090 | Bryan C Hoelzer | Anesthesiology | 320 River Park Dr Ste 255, Provo, UT 84604 | 2006-02-21 |
| 1437627080 | Advanced Spine and Pain Pllc | Anesthesiology | 11760 S 700 E Ste 112, Draper, UT 84020-6605 | 2018-11-12 |
| 1508216680 | Rayhan A. Tariq | Anesthesiology | 30 N 1900 E Rm 3c444, Salt Lake City, UT 84132-0002 | 2016-06-20 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.