Provider Demographics
NPI:1376844886
Name:OSTEOARTHRITIS CENTERS OF AMERICA MEDICAL GROUP PC
Entity Type:Organization
Organization Name:OSTEOARTHRITIS CENTERS OF AMERICA MEDICAL GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHRADER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-856-9778
Mailing Address - Street 1:14587 S 790 W STE A
Mailing Address - Street 2:STE A
Mailing Address - City:BLUFFDALE
Mailing Address - State:UT
Mailing Address - Zip Code:84065-2320
Mailing Address - Country:US
Mailing Address - Phone:801-478-2526
Mailing Address - Fax:801-931-2498
Practice Address - Street 1:14587 S 790 W
Practice Address - Street 2:STE A
Practice Address - City:BLUFFDALE
Practice Address - State:UT
Practice Address - Zip Code:84065-2320
Practice Address - Country:US
Practice Address - Phone:801-478-2526
Practice Address - Fax:801-931-2498
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-15
Last Update Date:2011-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain