1326487018 NPI number — PRECISION PAIN TREATMENT CLINIC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326487018 NPI number — PRECISION PAIN TREATMENT CLINIC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRECISION PAIN TREATMENT CLINIC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1326487018
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/17/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14 CEDAR SWAMP RD
Provider Second Line Business Mailing Address:
LOWER CENTER
Provider Business Mailing Address City Name:
SMITHFIELD
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02917-2490
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-232-0060
Provider Business Mailing Address Fax Number:
401-232-0064

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14 CEDAR SWAMP RD
Provider Second Line Business Practice Location Address:
LOWER CENTER
Provider Business Practice Location Address City Name:
SMITHFIELD
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02917-2490
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-232-0060
Provider Business Practice Location Address Fax Number:
401-232-0064
Provider Enumeration Date:
06/17/2013

Additional Information

Authorized Official

Authorized Official Last Name:
PERRY
Authorized Official First Name:
KEITH
Authorized Official Middle Name:
ARTHUR
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
401-456-3136

Provider Taxonomy Codes

  • Taxonomy code: 208VP0014X , with the licence number:  MD07817 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 9002571 , issued by the state of ( RI ) . This identifiers is of the category "MEDICAID".




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