Organization
SPINE AND SPORTS MEDICINE INC
Active
Organization
SPINE AND SPORTS MEDICINE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHARLES MIKELL BOVA M.D. (PRESIDENT)
(435) 640-6220
Entity
Organization
Contact information
Practice address
3336 PIONEER PKWY, SUITE 204, WEST VALLEY CITY, UT 84120-2000
(801) 964-3249
Mailing address
3065 OAK RIM LN, PARK CITY, UT 84060-6804
(435) 655-8468
Taxonomy
Speciality
Code
Description
License number
State
204C00000X
Sports Medicine (Neuromusculoskeletal Medicine) Physician
6053003-1204
UT
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
185699
UT
208VP0014X
Interventional Pain Medicine Physician
Primary
6053003-1204
UT
Other
Enumeration date
12/19/2006
Last updated
09/11/2025
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