Provider Demographics
NPI:1760985089
Name:ESSENTIAL INJECTIONS P.C.
Entity Type:Organization
Organization Name:ESSENTIAL INJECTIONS P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:SHAD
Authorized Official - Middle Name:W
Authorized Official - Last Name:TILLOTSON
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:385-455-3899
Mailing Address - Street 1:4612 N INDEPENDENCE WAY
Mailing Address - Street 2:
Mailing Address - City:EAGLE MOUNTAIN
Mailing Address - State:UT
Mailing Address - Zip Code:84005-6082
Mailing Address - Country:US
Mailing Address - Phone:385-455-3899
Mailing Address - Fax:
Practice Address - Street 1:4612 N INDEPENDENCE WAY
Practice Address - Street 2:
Practice Address - City:EAGLE MOUNTAIN
Practice Address - State:UT
Practice Address - Zip Code:84005-6082
Practice Address - Country:US
Practice Address - Phone:385-455-3899
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-13
Last Update Date:2018-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6223314-4405363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty