Provider Demographics
NPI:1942571229
Name:OSTEOARTHRITIS CENTERS OF AMERICA MEDICAL GROUP PC
Entity Type:Organization
Organization Name:OSTEOARTHRITIS CENTERS OF AMERICA MEDICAL GROUP PC
Other - Org Name:OSTEOARTHRITIS CENTERS OF AMERICA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTIAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:CRAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-258-1482
Mailing Address - Street 1:14587 S 790 W
Mailing Address - Street 2:SUITE A200
Mailing Address - City:BLUFFDALE
Mailing Address - State:UT
Mailing Address - Zip Code:84065-2319
Mailing Address - Country:US
Mailing Address - Phone:801-478-2526
Mailing Address - Fax:801-931-2498
Practice Address - Street 1:1097 N ROSARIO ST
Practice Address - Street 2:SUITE 110
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-8095
Practice Address - Country:US
Practice Address - Phone:208-906-8322
Practice Address - Fax:208-629-7059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-19
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDC190256261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain