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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