Healthcare Provider Details

I. General information

NPI: 1538656160
Provider Name (Legal Business Name): PREMIER PAIN CENTERS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2018
Last Update Date: 08/20/2025
Certification Date: 08/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2071 N COLLINS BLVD STE 100
RICHARDSON TX
75080-2696
US

IV. Provider business mailing address

2071 N COLLINS BLVD STE 100
RICHARDSON TX
75080-2696
US

V. Phone/Fax

Practice location:
  • Phone: 469-454-6966
  • Fax:
Mailing address:
  • Phone: 469-575-6438
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberR2266
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: RAO K ALI
Title or Position: OWNER
Credential: MD
Phone: 732-766-4107