Provider Demographics
NPI:1003441858
Name:SOUTHWEST SPINE AND PAIN CARE SPECIALISTS, LLC
Entity Type:Organization
Organization Name:SOUTHWEST SPINE AND PAIN CARE SPECIALISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:FRIEDEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:435-656-2424
Mailing Address - Street 1:652 S MEDICAL CENTER DR STE 110
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-7077
Mailing Address - Country:US
Mailing Address - Phone:435-656-2424
Mailing Address - Fax:435-986-7092
Practice Address - Street 1:2051 E RED HILLS PKWY STE 7
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-8671
Practice Address - Country:US
Practice Address - Phone:435-703-2930
Practice Address - Fax:435-703-2933
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTHWEST SPINE AND PAIN CARE SPECIALISTS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-03-11
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory