Provider Demographics
NPI:1235710369
Name:ASPEN ORTHOPEDIC PAIN AND SPINE LLC
Entity Type:Organization
Organization Name:ASPEN ORTHOPEDIC PAIN AND SPINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:LYMAN
Authorized Official - Last Name:CONDIE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:801-224-8800
Mailing Address - Street 1:84 W 4800 S STE 101
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-3781
Mailing Address - Country:US
Mailing Address - Phone:801-224-8800
Mailing Address - Fax:801-852-0584
Practice Address - Street 1:84 W 4800 S STE 101
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-3781
Practice Address - Country:US
Practice Address - Phone:801-224-8800
Practice Address - Fax:801-852-0584
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-20
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty