Healthcare Provider Details

I. General information

NPI: 1033523063
Provider Name (Legal Business Name): PRECISION PAIN TREATMENT CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2014
Last Update Date: 09/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 CEDAR SWAMP RD
SMITHFIELD RI
02917-2448
US

IV. Provider business mailing address

14 CEDAR SWAMP RD
SMITHFIELD RI
02917-2448
US

V. Phone/Fax

Practice location:
  • Phone: 401-231-0060
  • Fax: 401-231-0064
Mailing address:
  • Phone: 401-231-0060
  • Fax: 401-231-0064

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: KEITH PERRY
Title or Position: MD
Credential: MD
Phone: 401-231-0060