Provider Demographics
NPI:1407304454
Name:EASTERN UTAH PAIN
Entity Type:Organization
Organization Name:EASTERN UTAH PAIN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:
Authorized Official - Last Name:BEECHER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:435-613-7246
Mailing Address - Street 1:1330 W 720 N
Mailing Address - Street 2:
Mailing Address - City:PRICE
Mailing Address - State:UT
Mailing Address - Zip Code:84501-4623
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:230 N HOSPITAL DR
Practice Address - Street 2:SUITE 2
Practice Address - City:PRICE
Practice Address - State:UT
Practice Address - Zip Code:84501-4221
Practice Address - Country:US
Practice Address - Phone:435-613-7246
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-20
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty