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Organization

POWERSMD WELLNESS MEDICAL GROUP, INC.

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. THOMAS S. POWERS M.D. (PRESIDENT)
(714) 903-4570
Entity
Organization

Contact information

Practice address
6552 BOLSA AVE, SUITE H, HUNTINGTON BEACH, CA 92647-2660
(714) 903-4570
(714) 903-4571
Mailing address
428 MAIN ST, SUITE 101, HUNTINGTON BEACH, CA 92648-8142
(714) 843-0400
(714) 969-4001

Taxonomy

Speciality
Code
Description
License number
State
207RA0401X
Addiction Medicine (Internal Medicine) Physician
G15640
CA
208D00000X
General Practice Physician
Primary
G15640
CA
208VP0000X
Pain Medicine Physician
G15640
CA
208VP0014X
Interventional Pain Medicine Physician
G15640
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
G15640
LICENSE
CA
Enumeration date
09/27/2013
Last updated
09/27/2013
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