Provider Demographics
NPI:1417253907
Name:OMEGA INTERVENTIONAL PAIN PLLC
Entity Type:Organization
Organization Name:OMEGA INTERVENTIONAL PAIN PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:PULLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-261-4988
Mailing Address - Street 1:3838 S 700 E
Mailing Address - Street 2:STE 300
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84106-1466
Mailing Address - Country:US
Mailing Address - Phone:801-261-4988
Mailing Address - Fax:
Practice Address - Street 1:3838 S 700 E
Practice Address - Street 2:STE 300
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84106-1466
Practice Address - Country:US
Practice Address - Phone:801-261-4988
Practice Address - Fax:801-269-9425
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-01
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
No2084P2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT13281983-8906OtherUTAH LICENSE NUMBER