Proactive Pain Center

Primary specialty

Preferred Provider OrganizationTaxonomy code 305R00000X

Legal business name

PROACTIVE PAIN CENTER

Practice address

10965 S State St
Sandy, UT 84070-4270

Phone

(385) 414-6267

NPI assigned

May 8, 2015

Last updated

Jul 21, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Jodie Cunningham

Title

Owner

Phone

(385) 414-6267

Specialties & licenses 2

Addresses

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

{
    "created_epoch": "1431043200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1770961955",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10965 S STATE ST",
            "city": "SANDY",
            "state": "UT",
            "postal_code": "840704270",
            "telephone_number": "385-414-6267"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10965 S STATE ST",
            "city": "SANDY",
            "state": "UT",
            "postal_code": "840704270",
            "telephone_number": "385-414-6267"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROACTIVE PAIN CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-05-08",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "CUNNINGHAM",
        "authorized_official_first_name": "JODIE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "385-414-6267"
    },
    "taxonomies": [
        {
            "code": "305R00000X",
            "taxonomy_group": "",
            "desc": "Preferred Provider Organization",
            "state": "UT",
            "license": null,
            "primary": true
        },
        {
            "code": "305S00000X",
            "taxonomy_group": "",
            "desc": "Point of Service",
            "state": "UT",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Premise Health of Utah Medical PC (NICE Health Center)
• Valerie Price
• Samantha Michelle Primavera, APRN, PMHNP-BC
• Jessica Prince
• PRN Medical Services, LLC (Symbius Medical, LLC)
• Promptcare Laboratories
• Propertunity Metrix (Lumina Care & Wellness)
• Prosocial Work Psychotherapy Services P.C.
• Protectus Wound Care
• Provas of Salt Lake, LLC

• Preferred Provider Organization in Sandy, UT
• Providers in Sandy, UT by specialty
• Preferred Provider Organization in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.