Healthcare Provider Details

I. General information

NPI: 1669242012
Provider Name (Legal Business Name): PRECISION PAIN ALLIANCE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2024
Last Update Date: 01/15/2024
Certification Date: 01/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1517 LONGFORD CT
WALNUT CREEK CA
94598-1143
US

IV. Provider business mailing address

1517 LONGFORD CT
WALNUT CREEK CA
94598-1143
US

V. Phone/Fax

Practice location:
  • Phone: 913-636-7059
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MORGAN ALEXANDER WELCH
Title or Position: CEO
Credential: DO
Phone: 913-636-7059