Provider Demographics
NPI:1871263178
Name:SOUTHWEST SPINE AND PAIN CARE SPECIALISTS, LLC
Entity Type:Organization
Organization Name:SOUTHWEST SPINE AND PAIN CARE SPECIALISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:JON
Authorized Official - Middle Name:B
Authorized Official - Last Name:OBRAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:435-215-0230
Mailing Address - Street 1:PO BOX 912042
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84791-2042
Mailing Address - Country:US
Mailing Address - Phone:435-215-0230
Mailing Address - Fax:
Practice Address - Street 1:2891 E MALL DRIVE
Practice Address - Street 2:STE 200
Practice Address - City:SAINT GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790
Practice Address - Country:US
Practice Address - Phone:435-688-1665
Practice Address - Fax:435-619-8634
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTHWEST SPINE AND PAIN CARE SPECIALISTS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-09-17
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty