Provider Demographics
NPI:1457035370
Name:PREMIER PAIN & WELLNESS
Entity Type:Organization
Organization Name:PREMIER PAIN & WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:DAIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-644-7004
Mailing Address - Street 1:9242 W UNION HILLS DR # D100-101
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382-8218
Mailing Address - Country:US
Mailing Address - Phone:602-644-7004
Mailing Address - Fax:
Practice Address - Street 1:9242 W UNION HILLS DR # D100-101
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-8218
Practice Address - Country:US
Practice Address - Phone:602-644-7004
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-12
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty