Healthcare Provider Details

I. General information

NPI: 1205494440
Provider Name (Legal Business Name): INNOVATIVE PAIN AND WELLNESS PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2019
Last Update Date: 03/09/2020
Certification Date: 03/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22601 N 19TH AVE STE 100
PHOENIX AZ
85027-1324
US

IV. Provider business mailing address

18511 N SCOTTSDALE RD STE 202
SCOTTSDALE AZ
85255-9694
US

V. Phone/Fax

Practice location:
  • Phone: 623-231-2443
  • Fax:
Mailing address:
  • Phone: 480-306-7242
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: DANIEL KARL OCONNOR
Title or Position: OWNER, MD
Credential:
Phone: 480-306-7242