Provider Demographics
NPI:1891320644
Name:SOUTHWEST SPINE AND PAIN CARE SPECIALISTS, LLC
Entity Type:Organization
Organization Name:SOUTHWEST SPINE AND PAIN CARE SPECIALISTS, LLC
Other - Org Name:SOUTHWEST SPINE AND PAIN CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:FRIEDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-656-2424
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:435-986-7092
Practice Address - Street 1:301 N 200 E STE 2A
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-3040
Practice Address - Country:US
Practice Address - Phone:435-688-7246
Practice Address - Fax:435-688-1363
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTHWEST SPINE AND PAIN CARE SPECIALISTS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-03-11
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports MedicineGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Multi-Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
No207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty