Provider Demographics
NPI:1154144459
Name:SMITH'S PAIN MANAGEMENT
Entity type:Organization
Organization Name:SMITH'S PAIN MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:NP-C
Authorized Official - Phone:435-313-3142
Mailing Address - Street 1:10648 S REMBRANDT LN
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84070-5224
Mailing Address - Country:US
Mailing Address - Phone:435-313-3142
Mailing Address - Fax:801-705-0118
Practice Address - Street 1:10648 S REMBRANDT LN
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84070-5224
Practice Address - Country:US
Practice Address - Phone:435-313-3142
Practice Address - Fax:801-705-0118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-05
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain