Provider Demographics
NPI:1003504192
Name:SOUTH HILL PAIN & WELLNESS PLLC
Entity Type:Organization
Organization Name:SOUTH HILL PAIN & WELLNESS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:A
Authorized Official - Last Name:BARCLAY
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:425-403-9331
Mailing Address - Street 1:18930 BOTHELL EVERETT HWY APT C305
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98012-5230
Mailing Address - Country:US
Mailing Address - Phone:425-403-9331
Mailing Address - Fax:
Practice Address - Street 1:3424 S GRAND BLVD
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99203-2621
Practice Address - Country:US
Practice Address - Phone:509-720-1073
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-26
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)Group - Multi-Specialty
No163WP0000XNursing Service ProvidersRegistered NursePain ManagementGroup - Multi-Specialty