Provider Demographics
NPI:1326487018
Name:PRECISION PAIN TREATMENT CLINIC
Entity Type:Organization
Organization Name:PRECISION PAIN TREATMENT CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:ARTHUR
Authorized Official - Last Name:PERRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:401-456-3136
Mailing Address - Street 1:14 CEDAR SWAMP RD
Mailing Address - Street 2:LOWER CENTER
Mailing Address - City:SMITHFIELD
Mailing Address - State:RI
Mailing Address - Zip Code:02917-2490
Mailing Address - Country:US
Mailing Address - Phone:401-232-0060
Mailing Address - Fax:401-232-0064
Practice Address - Street 1:14 CEDAR SWAMP RD
Practice Address - Street 2:LOWER CENTER
Practice Address - City:SMITHFIELD
Practice Address - State:RI
Practice Address - Zip Code:02917-2490
Practice Address - Country:US
Practice Address - Phone:401-232-0060
Practice Address - Fax:401-232-0064
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ASSOCIATES IN ANESTHESIA, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-06-17
Last Update Date:2013-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD07817208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI9002571Medicaid
RI059002571Medicare PIN