Basic Information
| Provider Information | |||||||||
| NPI: | 1205494440 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | INNOVATIVE PAIN AND WELLNESS PLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 18511 N SCOTTSDALE RD STE 202 | ||||||||
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| City: | SCOTTSDALE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852559694 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4803067242 | ||||||||
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| Practice Location | |||||||||
| Address1: | 22601 N 19TH AVE STE 100 | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850271324 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6232312443 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/03/2019 | ||||||||
| LastUpdateDate: | 03/09/2020 | ||||||||
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| AuthorizedOfficialLastName: | OCONNOR | ||||||||
| AuthorizedOfficialFirstName: | DANIEL | ||||||||
| AuthorizedOfficialMiddleName: | KARL | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER, MD | ||||||||
| AuthorizedOfficialTelephone: | 4803067242 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | INNOVATIVE PAIN AND WELLNESS PLC | ||||||||
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| NPICertificationDate: | 03/09/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology | 208VP0000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pain Medicine | Pain Medicine | 207LP2900X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine |
No ID Information.