Provider Demographics
NPI:1437488798
Name:UTAH PAIN RELIEF INSTITUTE SOUTH, LLC
Entity Type:Organization
Organization Name:UTAH PAIN RELIEF INSTITUTE SOUTH, LLC
Other - Org Name:UPRI SOUTH, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIE
Authorized Official - Middle Name:N
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-466-7246
Mailing Address - Street 1:10464 S REDWOOD RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-8501
Mailing Address - Country:US
Mailing Address - Phone:801-281-0555
Mailing Address - Fax:801-281-0444
Practice Address - Street 1:10464 S REDWOOD RD
Practice Address - Street 2:
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095-8501
Practice Address - Country:US
Practice Address - Phone:801-281-0555
Practice Address - Fax:801-281-0444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-16
Last Update Date:2010-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT09W56878174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty