Provider Demographics
NPI:1255844015
Name:ALPINE PAIN SOLUTIONS OF UTAH, INC
Entity Type:Organization
Organization Name:ALPINE PAIN SOLUTIONS OF UTAH, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:L
Authorized Official - Last Name:CHILD
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:801-766-6055
Mailing Address - Street 1:3051 W MAPLE LOOP DR STE 125
Mailing Address - Street 2:
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-5620
Mailing Address - Country:US
Mailing Address - Phone:801-766-6055
Mailing Address - Fax:888-611-8840
Practice Address - Street 1:3051 W MAPLE LOOP DR STE 125
Practice Address - Street 2:
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-5620
Practice Address - Country:US
Practice Address - Phone:801-766-6055
Practice Address - Fax:888-611-8840
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-14
Last Update Date:2020-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1063492304Medicaid