Spine and Sports Medicine Inc

Primary specialty

Interventional Pain Medicine PhysicianTaxonomy code 208VP0014X

License

6053003-1204 Issued in UT

Legal business name

SPINE AND SPORTS MEDICINE INC

Practice address

3336 Pioneer Pkwy
Suite 204
West Valley City, UT 84120-2000

Phone

(801) 964-3249

NPI assigned

Dec 19, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Charles Mikell Bova, M.D.NPI 1013071885

Title

President

Phone

(435) 640-6220

Specialties & licenses 3

Addresses

Tax ID family

Spine and Sports Medicine Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Spine & Sports Medicine

  • Pain Medicine Physician
  • West Valley City, UT
  • NPI 1558588475
  NPD tax ID

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Charles Mikell Bova, M.D.

  • Pain Medicine (Physical Medicine & Rehabilitation) Physician
  • West Valley City, UT
  • NPI 1013071885
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1166486400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757548800000",
    "number": "1073677845",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3065 OAK RIM LN",
            "city": "PARK CITY",
            "state": "UT",
            "postal_code": "840606804",
            "telephone_number": "435-655-8468"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3336 PIONEER PKWY",
            "address_2": "SUITE 204",
            "city": "WEST VALLEY CITY",
            "state": "UT",
            "postal_code": "841202000",
            "telephone_number": "801-964-3249"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPINE AND SPORTS MEDICINE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-19",
        "last_updated": "2025-09-11",
        "status": "A",
        "authorized_official_last_name": "BOVA",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "MIKELL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "435-640-6220",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "204C00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Neuromusculoskeletal Medicine, Sports Medicine",
            "state": "UT",
            "license": "6053003-1204",
            "primary": false
        },
        {
            "code": "2081P2900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation, Pain Medicine",
            "state": "UT",
            "license": "185699",
            "primary": false
        },
        {
            "code": "208VP0014X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": "UT",
            "license": "6053003-1204",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Julie Sotelo
• Edward G Southwick, M.D.
• Michelle Denae Speckman, RPH
• Elizabeth Spencer
• Spine & Sports Medicine
• Warren R Stack, MD
• William Stark
• Lisa Paxton Starr
• Gail Ann Starring, PTA
• McKenzie Stauffer

• Interventional Pain Medicine Physician in West Valley City, UT
• Providers in West Valley City, UT by specialty
• Interventional Pain Medicine Physician in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.