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Contact Information

IDAHO PAIN CENTER AND ANESTHESIA PC
286 N GATEWAY DR
PROVIDENCE, UT84332-9733
 Phone: 435-755-9184
 Fax: 435-755-9148
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Pain Medicine

208VP0000X 72 Physician/Pain Management
 

Interventional Pain Medicine

208VP0014X 09 Physician/Interventional Pain Management
Indicates primary specialty

NPI Profile & details for IDAHO PAIN CENTER AND ANESTHESIA PC

NPI Number 1255520037
LBN Legal business name IDAHO PAIN CENTER AND ANESTHESIA PC
Authorized official SHANNA BEDELL - (ACCOUNTS MANAGER)
Entity Organization
Organization subpart 1 No
Enumeration date 10/17/2007
Last updated 07/18/2013 - About 13 years ago
Identifiers
UT License # 329116-1204
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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