| Organization Name: | PAIN MANAGEMENT PROFESSIONALS LLC |
| NPI Number: | 1255795134 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ANGIE WILCOX (OWNER) |
| Mailing Address: | 4541 S 700 E Suite 100 Murray |
| State: | UT US |
| Postal Code: | 841074118 |
| Phone Number: | 8017131560 |
| Fax Number: | 8017131562 |
| NPI Enumeration Date: | 04/07/2016 |
| NPI Last Update Date: | 04/07/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |