Provider Demographics
NPI:1063721850
Name:ALTA PAIN PHYSICIANS, PLLC
Entity type:Organization
Organization Name:ALTA PAIN PHYSICIANS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RYSHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:HUBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-750-8210
Mailing Address - Street 1:11333 S 1000 E
Mailing Address - Street 2:#102
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84094-5428
Mailing Address - Country:US
Mailing Address - Phone:801-462-2205
Mailing Address - Fax:801-748-1030
Practice Address - Street 1:11333 S 1000 E
Practice Address - Street 2:#102
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84094-5428
Practice Address - Country:US
Practice Address - Phone:801-462-2205
Practice Address - Fax:801-750-1030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-28
Last Update Date:2010-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty